The Annals of Thoracic Surgery, Vol 57, 1559-1563, Copyright © 1994 by The Society of Thoracic Surgeons
Early diagnosis of acute rejection by pulmonary hemodynamics after single-lung transplantation
C Yamashita, H Yamamoto, S Tobe, H Oobo, H Nakamura and M Okada
Department of Surgery, Kobe University School of Medicine, Japan.
The aim of this study was to facilitate the early diagnosis of acute
rejection after single-lung transplantation based on pulmonary hemodynamic
findings. A Doppler flowmeter was placed in the ascending aorta and the
pulmonary artery of adult mongrel dogs after single-lung transplantation.
The pulmonary hemodynamics of the lung graft were then evaluated during the
early postoperative period and during subsequent rejection. Twenty dogs
were divided into three groups. Group 1 consisted of 6 dogs that underwent
autotransplantation of the left lung. Group 2 was made up of 6 dogs that
underwent allotransplantation of the left lung without immunosuppressant
therapy. Group 3 consisted of 8 dogs that underwent allotransplantation of
the left lung and were treated with 10 mg/kg of cyclosporine and 4 mg/kg of
azathioprine. Pulmonary hemodynamics and chest roentgenograms were studied
for more than 2 weeks postoperatively. Open lung biopsy was performed in
some dogs to obtain graft specimens for histologic examination. The left
pulmonary artery flow rate (percentage of pulmonary graft blood flow to
cardiac output) decreased slightly after operation in group 1, and
decreased to 14.4% after 1 week and to zero on postoperative day 10 in
group 2. The pulmonary vascular resistance of the grafts in group 2 also
increased exponentially. In contrast, the left pulmonary artery flow rates
decreased to 29.1% on the day after operation in group 3, but recovered to
38.5% on postoperative day 14. Within a mean of 3.7 days of
immunosuppressant discontinuation, the left pulmonary artery flow rates
decreased to less than 12.7%, with a marked increase in pulmonary
resistance.(ABSTRACT TRUNCATED AT 250 WORDS)
