Am. J. Respir. Crit. Care Med., Volume 165, Number 2, January 2002, 216-220

Bronchial Artery Revascularization Affects Graft Recovery after Lung Transplantation

KAI NOWAK, MARKUS KAMLER, MATTHIAS BOCK, JOHANN MOTSCH, SIEGFRIED HAGL, HEINZ JAKOB, and MARTHA-MARIA GEBHARD

Departments of Experimental Surgery, Cardiac Surgery, and Anaesthesiology, University of Heidelberg, Heidelberg, Germany; and Department of Thoracic and Cardiovascular Surgery, University of Essen, Essen, Germany

Restitution of bronchial artery circulation might alter ischemia- reperfusion injury and improve organ function after lung transplantation. Weight-matched dogs underwent a left lung allotransplantation either with bronchial artery revascularization (BAR; n = 6) or as conventional lung transplantation (LTX; n = 6), to evaluate effects of BAR on lung cell function over a period of 5 h postischemically. Lactate dehydrogenase (LDH) and marker enzymes for pneumocytes type I (carboxypeptidase M [CPM], pneumocytes type II (alkaline phosphatase [AP]), and pulmonary endothelium (angiotensin-converting-enzyme [ACE]) were determined from bronchoalveolar lavage fluid. Donor lungs were preserved with Euro-Collins solution. Total ischemic time was kept at 6 h. CPM and LDH activities were significantly higher in both groups at 2 h and 4 h of reperfusion compared with control dogs (p < 0.01). AP and ACE activities in lavage after 2 h of reperfusion were significantly elevated in animals that underwent LTX (AP: 60 ± 28 IU/L; ACE: 1.39 ± 1.13 IU/L) compared with animals with BAR (AP: 33 ± 29 IU/L; ACE: 0.35 ± 0.6 IU/L; p < 0.05) and with control animals (AP: 13.58 ± 11.0 IU/L; ACE: 0.06 ± 0.14 IU/L; p < 0.01). According to these results, BAR protects pulmonary endothelium and type II pneumocytes in the early phase after lung transplantation and might have consequences for lung tissue in the long term.

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