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J Thorac Cardiovasc Surg 1994;107:946-947
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Bronchial circulation and airway complications after lung transplantation: Possible role of pulmonary rejection

Chest Disease Research Institute
Kyoto University
Kyoto, Japan

Hans-Joachim Schäfers, MD

Division of Thoracic and Cardiovascular Surgery
Surgical Center
Medical School Hannover
Konstanty-Gutschow-Str. 8
30625 Hannover, Germany

Reply to the Editor:

The comments of Dr. Takao and his colleagues are appreciated. They ¹ have previously shown that there is a possible association between the degree of pulmonary rejection and concomitant decrease in bronchial mucosal blood flow in lung transplantation. The data they have now added support the hypothesis that rejection may be a risk factor for the occurrence of airway complications in lung transplantation. Because rejection is manifested in blood vessels and perivascular tissue primarily, this assumption appears logical.

Overall, however, one has to weigh the negative effects of immunosuppression (e.g., impairment of wound healing) against the positive effects in suppressing the immune response. In the early experience with lung transplantation, the negative effects on wound healing were believed to be of greater importance. ² More recent experimental and clinical data, however, indicate that the overall effect of corticosteroids may be positive, that is, that of lowering the prevalence of airway complications. ^3-5 The data published by Takao and colleagues ¹ seem to offer a clear explanation for this observation. Because they used cyclosporine and azathioprine without corticosteroids, however, their results may not be directly comparable with those of other authors. In our investigation, there was also a loose association between degree of rejection and severity of histologic changes in the airways, as stated in the manuscript. ³ This observation did not gain significance by analysis of individual data. Overall, we agree with Dr.Takao that rejection may be an important factor in the pathogenesis of airway complications after lung transplantation.

References

1. Takao M, Katayama Y, Onoda K, et al. Significance of bronchial musocal blood flow for the monitoring of acute rejection in lung transplantation. J Heart Lung Transplant 1991;10:956-67.[Medline]
   
2. Patterson GA, Cooper JD. Status of lung transplantation. Surg Clin North Am 1988;68:545-58.[Medline]
   
3. Inui K, Schäfers H-J, Aoki M, et al. Bronchial circulation after experimental lung transplantation: the effect of long-term administration of prednisolone. J THORAC CARDIOVASC SURG 1993;105:474-9.[Abstract]
   
4. Miller JD, DeHoyos A. An evaluation of the role of omentopexy and of early perioperative corticosteroid administration in clinical lung transplantation. J THORAC CARDIOVASC SURG 1993;105:247-52.[Abstract]
   
5. Schäfers H-J, Haverich A, Wagner TOF, Wahlers T, Alken A, Borst HG. Decreased incidence of bronchial complications following lung transplantation. Eur J Cardiothorac Surg 1992;6:174-9.[Abstract]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Inui, K. Articles by Schäfers, H.-J. Search for Related Content PubMed Articles by Inui, K. Articles by Schäfers, H.-J.