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J Thorac Cardiovasc Surg 1997;114:186-194
© 1997 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

MATURE PULMONARY LOBAR TRANSPLANTS GROW IN AN IMMATURE ENVIRONMENT

Supported by the National Institutes of Health under RO1 grant HL 48242 and NRSA fellowship F32HL09115-01A1. Additional support from CNPq—Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brazil.

Presented in part October 6, 1996, at the Surgical Forum of the American College of Surgeons.

Received for publication Nov. 21, 1996 Revisions requested Feb. 24, 1997; revisions received March 18, 1997 Accepted for publication March 25, 1997. Address for reprints: Irving L. Kron, MD, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Box 310, University of Virginia Health Sciences Center, Charlottesville, VA 22908.

Abstract

Objective: Mature lobar transplantation will increase the pediatric donor organ pool, but it remains unknown whether such grafts will grow in a developing recipient and provide adequate long-term support. We hypothesized that a mature pulmonary lobar allograft implanted in an immature recipient would grow. Methods: We investigated our hypothesis in a porcine orthotopic left lung transplant model using animals matched by the major histocompatibility complex to minimize the effects of chronic rejection. Twenty-three immature animals (<12 weeks of age and <10 kg total body weight) received either sham left thoracotomy (SH control, n = 4), left upper lobectomy to study compensatory growth (UL control, n = 4), age-matched immature whole left lung transplants (IWL TXP, n = 6), mature (donor > 1 yr in age and > 40 kg in total body weight) left lower lobe transplants (MLL TXP, n = 5), or mature left upper lobe transplants (MUL TXP, n = 4). Twelve weeks after implantation, functional residual capacity of the left lung was measured and arterial blood gas samples were obtained after the native right lung had been excluded. The graft was excised and weighed, and samples for microscopy and wet/dry ratios were collected. Results: Initial and final graft weights were as follows: IWL TXP group (34.6 ± 1.5 and 107.8 ± 5.9 gm, p < 0.0001), MLL TXP group (72.4 ± 6.8 and 111.4 ± 8.7, p < 0.001), and MUL TXP group (32.8 ± 1.3 and 92.8 ± 7.1 gm, respectively, p < 0.004). No significant differences between groups were demonstrated when functional residual capacity, wet/dry ratios, or oxygenation were compared. Immunohistochemical staining for the nuclear antigen Ki-67 demonstrated dividing pneumocytes. Conclusions: We conclude that a mature lobar graft implanted into an immature recipient grows by pneumocyte division in this model. Mature lobar transplants can be expected to grow and provide adequate long-term function in developing recipients. J Thorac Cardiovasc Surg 1997;114:186-94

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