Historical Development of Pulmonary Transplantation

It is interesting to reflect on the historical development of lung transplantation and appreciate the contributions of so many individuals and institutions. The first reported lung transplant was actually a heterotopic heart-lung transplant from a kitten to an adult cat performed by Guthrie and reported by Carrell in 1906. In 1947 Price-Thomas performed the first human sleeve lobectomy and thereby achieved the first successful bronchial anastomotic healing. In the same year, Demikov reported his successful experience with canine lobar homografts. The most important preliminary investigation of canine lung transplantation was reported by Henri Metras in 1949. He developed techniques which have stood the test of time. He advocated a left atrial cuff anastomosis rather than individual pulmonary venous anastomosis. He suggested the appropriate sequence of anastomoses: bronchus, pulmonary artery, and left atrium, which is now employed in most centers. Another of his major contributions was to advocate restoration of systemic bronchial artery flow. He did this by anastomosing the donor bronchial artery origin on a patch of aorta to the left subclavian artery. Whereas restoration of bronchial artery circulation has not yet gained widespread acceptance in the lung transplant community, Metras recognized that the ischemic donor bronchus would be the source of considerable morbidity in human lung transplantation. Encouraged by the contributions of Metras, a number of centers were actively involved in lung transplant research over the next 10 years. By the early 1960s it had been demonstrated that transplanted canine autografts and allografts were capable of supporting respiratory function. In 1963, Dr. James Hardy of Mississippi performed the first human lung transplantation. The recipient was a male convict serving a life sentence. He had presented with a hilar bronchogenic carcinoma and severe coexisting emphysema. The recipient survived 18 days before succumbing to malnutrition and renal failure. Despite the ultimate failure in this case, it did demonstrate that a human lung allograft was capable of early postoperative function. Hardy's attempt was followed by some 40 others over the next 15 years. All were unsuccessful. This is not surprising, given the fact that recipients were poorly selected, donor organs were of inconsistent quality, preservation was nonexistent, immunosuppression was inadequate, and rejection monitoring was imprecise. The only cause for optimism amongst this long list of failures was a case of Derome. The recipient was a young man with end-stage silicosis who received a right-lung transplant. The patient was hospitalized for 8 months postoperatively and survived only a brief