Physiologic Changes Associated With Autotransplantation Of The Lung

Abstract

Following pulmonary autotransplantation in 5 dogs, cardiac catheterization and ventilation studies showed both high pulmonary vascular resistance and decreased diffusion in the autotransplanted lung. Fifty-nine dogs were given intravenous injections of radioactive Xenon133, and perfusion ratios of the control right lung and the manipulated left lung were obtained by comparing counts over both chest walls. The following steps in autotransplantation of the lung, were evaluated: thoracotomy, denervation, bronchial artery ligation, division of the pulmonary artery, division of the pulmonary veins, hilar stripping, division of the bronchus and pulmonary artery, and left lung reimplantation. At autopsy animals having abnormal Xenon tests had some obstruction of one or more of the anastomoses, while the other animals were essentially normal. Necrosis of bronchi at suture lines was common. Pulmonary hypertension of the autotransplanted lung was due to failure of vascular anastomoses, especially of veins. Transection of nerves, lymphatics, and bronchial arteries alone had little effect. Studies in 3 monkeys confirmed these findings.