Pulmonary Reimplantation Response

REIMPLANTATION or autotransplantation of the lung is a formidable procedure involving division of many structures. In the past, reimplantation of the canine lung presented technical problems which resulted in high surgical mortality and appreciable compromise of the bronchial and vascular anastomoses with consequent functional impairments in surviving animals.3'6"11,18,20'24 Recent technical improvements have made it possible to minimize defects at the bronchial and vascular anastomoses;2'22 a reimplanted lung can now recover normal morphology and function remarkably well if the bronchus and major vessels are adequately reconstructed.10'20.23 After technically flawless reimplantation, however, functional defects may occur in the early postoperative period. These defects are largely reversible'3'21 and may be attributed to disruption of nerves, lymphatics and bronchial vessels and/or to ischemic injury.1"7"1'2,8 We have been investigating the mechanisms of pulmonary allograft rejection in dogs using serial chest roentgenography and pulmonary angiography with simultaneous lung biopsy.1'5"6 Serial chest roentgenography is an important means of monitoring the status of the allograft in the postoperative period. Since the anticipated responses to autotransplantation have not been adequately defined, it may be difficult to determine whether a postoperative pulmonary roentgenologic abnormality is due to rejection or reimplantation. The present study was undertaken to allow us to establish