The Journal of Thoracic and Cardiovascular Surgery, Vol 86, 537-542, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Single lung transplantation with cyclosporin immunosuppression. Evaluation of canine and human recipients
SL Kamholz, FJ Veith, FP Mollenkopf, KL Pinsker, RR Kaleya, AJ Norin, ML Gliedman, EE Emeson, AD Merav and R Brodman
Cyclosporin, a potent new immunosuppressive agent, was used (alone or in
combination with other drugs) in 28 canine single lung allograft
recipients. Mean recipient survival with good allograft function was 155
days with cyclosporin and far exceeded that obtained in previous single
lung allograft recipients treated with standard immunosuppression (15 to 22
days). The results of these experiments were as follows: (1) 20% of the
recipient animals exhibited no evidence of rejection whatsoever; (2) four
of 28 animals survived more than 350 days with good allograft function; (3)
79% of the animals exhibited some evidence of rejection that was easily
reversed in 74% of instances with corticosteroids; (4) 10 of 28 animals
exhibited good lung allograft function 5 months or more after operation;
(5) in cyclosporin- treated lung allograft recipients, rejection was
diagnosed by the presence of infiltrate on chest roentgenogram, analysis of
the cellular content of bronchoalveolar lavage samples, and decreased
perfusion on 99mtechnetium lung scan; (6) complete healing without stenosis
of the bronchial anastomosis occurred in 82% of the animals studied. One of
two patients treated with cyclosporin after undergoing single lung
allografting survived 7 weeks after transplantation and 4 weeks after
contralateral pneumonectomy. Episodes of rejection were reversible, and the
bronchial anastomosis healed normally. This overall experience indicates
that cyclosporin, although not a perfect immunosuppressive agent, increases
the likelihood of success with therapeutic single lung transplantation.
