Il trapianto di polmone sinistro nel maiale : tecnica e risultati

Laboratory research has solved many of the problems that hindered the successful clinical application of lung transplantation. Changing attitudes to animals in research and practical considerations have recently made it more difficult to use dogs and baboons in laboratories. This prompted the Authors to evaluate whether the pig might be a suitable substitute for single left lung transplants. Twenty-nine paired pigs were used. The first transplants on 13 pairs (group 1) were done to adapt the lung transplant technique to pigs; later transplants on 16 pig pairs (group 2) were done to evaluate both operative survival and function and histological modifications of the transplanted lung in the absence of immunosuppressive treatment. Surgical and anaesthetic techniques are described in detail for both donor and recipient. Transplantation was performed by means of venous, arterial and bronchial anastomoses. No direct bronchial revascularization was attempted. An inflatable cuff was placed around the right pulmonary artery in order to evaluate the function of the transplanted lung alone. Haemodynamic and blood gas changes were assessed during operation. The survival rate in group 2 was 68%. Perfusion was maintained in the transplanted lung although vascular resistance was higher than in the native lung. PaO2 did not drop significantly after the occlusion of the right pulmonary artery; this suggests that the function of the transplanted lung was preserved. The pigs were killed on the third postoperative day. Vascular and bronchial anastomoses were patent and intact, but the transplanted lung was macroscopically and microscopically altered. Lung transplants can be performed in pigs and the transplanted lung seems to be capable of functioning immediately after the operation. Alteration in the lung after 3 days is probably due to rejection.