Lung transplant airway hypoxia: A diathesis to fibrosis?

Gundeep S. Dhillon, Martin R. Zamora, Justus E. Roos, Deirdre Sheahan, Ramachandra R. Sista, Pieter Van Der Starre, David Weill, Mark R. Nicolls

Research output: Contribution to journalArticle

55 Scopus citations

Abstract

Rationale: Chronic rejection, manifested pathologically as airway fibrosis, is the major problem limiting long-term survival in lung transplant recipients. Airway hypoxia and ischemia, resulting from a failure to restore the bronchial artery (BA) circulation at the time of transplantation, may predispose patients to chronic rejection. To address this possibility, clinical information is needed describing the status of lung perfusion and airway oxygenation after transplantation. Objectives: To determine the relative pulmonary arterial blood flow, airway tissue oxygenation and BA anatomy in the transplanted lung was compared with the contralateral native lung in lung allograft recipients. Methods: Routine perfusion scans were evaluated at 3 and 12 months after transplantation in 15 single transplant recipients. Next, airway tissue oximetry was performed in 12 patients during surveillance bronchoscopies in the first year after transplant and in 4 control subjects. Finally, computed tomography (CT)-angiography studies on 11 recipients were reconstructed to evaluate the post-transplant anatomy of the BAs. Measurements and Main Results: By 3 months after transplantation, deoxygenated pulmonary arterial blood is shunted away from the native lung to the transplanted lung. In the first year, healthy lung transplant recipients exhibit significant airway hypoxia distal to the graft anastomosis. CT-angiography studies demonstrate that BAs are abbreviated, generally stopping at or before the anastomosis, in transplant airways. Conclusions: Despite pulmonary artery blood being shunted to transplanted lungs after transplantation, grafts are hypoxic compared with both native (diseased) and control airways. Airway hypoxia may be due to the lack of radiologically demonstrable BAs after lung transplantation.

Original languageEnglish (US)
Pages (from-to)230-236
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume182
Issue number2
DOIs
StatePublished - Jul 15 2010

Keywords

  • Bronchial arteries
  • Fibrosis
  • Graft rejection
  • Ischemia
  • Lung transplantation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Dhillon, G. S., Zamora, M. R., Roos, J. E., Sheahan, D., Sista, R. R., Van Der Starre, P., Weill, D., & Nicolls, M. R. (2010). Lung transplant airway hypoxia: A diathesis to fibrosis? American journal of respiratory and critical care medicine, 182(2), 230-236. https://doi.org/10.1164/rccm.200910-1573OC