Ann Thorac Surg 1994;57:1559-1563
© 1994 The Society of Thoracic Surgeons
Early diagnosis of acute rejection by pulmonary hemodynamics after single-lung transplantation
Chojiro Yamashita, MD*,
Hidehiro Yamamoto, MD,
Satosi Tobe, MD,
Hidefumi Oobo, MD,
Hiroomi Nakamura, MD,
Masayosi Okada, MD
Second Division, Department of Surgery, Kobe University School of Medicine, Kobe, Japan
Accepted for publication October 14, 1993.
* Address reprint requests to Dr Yamashita, Second Division, Department of Surgery, Kobe University School of Medicine, 7-5-2 Kusunoki-cho Chuoku, Kobe, Japan 650.
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 flow-meter 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. Flow rates recovered to 42.1% within a mean of 4.3 days of methylprednisolone treatment for 3 days. Open lung biopsy specimens showed perivascular cuffing, although the chest roentgenogram findings remained unchanged. Changes in the pulmonary artery flow rate were found prior to any changes on the chest roentgenograms during early rejection. In conclusion, measurement of the pulmonary artery flow rate and pulmonary vascular resistance is useful for the early diagnosis of acute rejection after single-lung transplantation.
- Egan TM, Kaiser LR, Cooper KD. Lung transplantation Curr Probl Surg 1989;26:673-752.[Medline]
- Kamholz SL, Veith PJ, Mollenkopf FP. Single lung transplantation with cyclosporin immunosuppression. Evaluation of canine and human recipients J Thorac Cardiovasc Surg 1983;86:546-573.
- Higenbottam TW, Stewart S, Penketh A, Wallork J. Transbronchial lung biopsy for the diagnosis of rejection in heart-lung transplantation patient Transplantation 1988;46:532-539.[Medline]
- Griffith PB. Detection of rejection in the transplanted lungs and immunologyIn: Wallwork J, editor. Heart and heart-lung transplantation. Philadelphia: Saunders; 1988. pp. 507-522.
- Higenbottam T, Stewart S. The diagnosis of lung rejection and opportunistic infection by transbronchial lung biopsy Transplant Proc. 19. 1987. pp. 3777.
- Starnes V, Theodore J, Oyer PE, et al. Evaluation of heart-lung transplant recipients with prospective, serial transbronchial biopsies and pulmonary function studies J Thorac Cardiovasc Surg 1989;90:683-690.
- Siegelman SS, Sinha SBP, Veith FJ. Pulmonary reimplantation response Ann Surg 1973;177:30-36.[Medline]
- Prop J, Ehire MG, Crapo JD, Nieuwenhuis P, Wildevuur CRH. Reimplantation response in isografted rat lungs. Analysis of causal factors J Thorac Cardiovasc Surg 1984;87:702-711.[Abstract]
- Cagle PT, Truong LD, Holland VA, Lawrence EC, Noon GP, Greenberg SD. Lung biopsy evaluation of acute rejection versus opportunistic infection in lung transplantation patient Transplantation 1989;47:713-715.[Medline]
- Griffith BP, Durham SG, Hardesty RL, Trento A, Paradis IL. Acute rejection of heart-lung allograft and methods of its detection Transplant Proc. 19. 1987. pp. 2527-2530.
- Cooper JD. Lung transplantationIn: Baumgartner AW, Reitz AB, Achuff CS, editors. Heart and heart-lung transplantation. Philadelphia: Saunders; 1990. pp. 347-371.
- Mohiaddin RH, Paz R, Theodoropoulos S, Firmin DN, Longmore DB, Yacoub MH. Magnetic resonance characterization of pulmonary arterial blood flow after single lung transplantation J Thorac Cardiovasc Surg 1991;101:1016-1023.[Abstract]
- Levine SM, Jenkinson SG, Bryan CL, et al. Ventilation-perfusion inequalities during graft rejection in patients undergoing single lung transplantation for primary pulmonary hypertension Chest 1992;101:401-405.[Medline]
- Kramer MR, Marshall IR, McDougall IR, et al. The distribution of ventilation and perfusion after single-lung transplantation in patients with pulmonary fibrosis and pulmonary hypertension Transplant Proc. 23. 1991. pp. 1215-1216.
- Veith FJ. Cyclosporin A in experimental lung transplantation Transplantation 1981;32:474-481.[Medline]
- Doherty PS. Pulmonary perfusion during lung transplantation rejection and experimental pneumonia Transplantation 1992;53:533-535.[Medline]