HUMAN HOMOTRANSPLANTATION OF LEFT LUNG: REPORT OF A CASE

Within the past decade, advances in the fundamental research of immunity and improved surgical techniques have resulted in bringing closer the long awaited era of organ transplantation. Indeed, within recent months homotransplantations of lung’ and liver,2 as well as have been attempted in man. The whole field is so rapidly advancing that it is difficult to state fundamental principles, and one cannot help but feel that there are many factors involved in successful transplantations which are, as yet unrecognized. Since Dameshek5 first showed that the immune response could be altered in skin grafts by 6-mercaptopurine, further research has brought forth several promising agents which have proved efficacious in animals as well as in humans in suppressing the immune response. Despite these agents, the variability in our experimental experience in animal lung transplantation makes one feel that the genetic similarity of the donor and host are probably more important for a successful “take” than the means to suppress the immune response. Indeed, pathologists have difficulty in defining rejection, since it is so intimately involved with pathological changes which could be associated with poor surgical techniques, inadequate blood supply, and/ or infection. Probably the weakest link in prolongation of transplant survival today is the lack of a sensitive accurate method to determine imminent host rejection. Basic animal work is, of course, fundamental to the future of organ transplantation, but while this is in progress: efforts should be made in human application in an attempt to bridge the gap between the laboratory and the patient. However, each team must make its own decision as to when it is prepared to approach the clinical application. Our decision was dictated by having an otherwise healthy patient with advanced emphysema, a suitable 2 1-year-old healthy donor dying of a ruptured cerebral aneurysm, an enlightened host family, and a considerable experience in canine lung transplantation prior to clinical application.