Aspects of lung transplantation that contribute to increased severity of pneumonia: An experimental study

R. Aeba, J. E. Stout, N. A. Francalancia, R. J. Keenan, A. J. Duncan, S. A. Yousem, G. J. Burckart, V. L. Yu, B. P. Griffith

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

In lung or heart-lung transplant recipients, complications as a result of pulmonary infections continue to be the most frequent causes of morbidity and mortality. This study was undertaken to identify the contributions of (1) thoracotomy, (2) interruption of lymphatic vessels and bronchial arteries, (3) transplant procedure, (4) drug-induced immunosuppression, and (5) graft allogenicity to the increased risk of pneumonia in lung transplantation. Lewis rats were inoculated with 105 colony-forming units of Legionella pneumophila serogroup 1 by direct instillation into the trachea after one of the following: a general anesthetic with no operation; a left thoracotomy; a left thoracotomy with pulmonary hilar stripping; an isogeneic orthotopic left lung transplant with or without immunosuppression; or an allogeneic transplant with immunosuppression with Brown-Norway rats as donors. Immunosuppression was induced with an intramuscular injection of cyclosporine (25 mg/kg of body weight) from the innoculation day to day 3. All rats were killed on day 6, and severity of infection was determined by quantitative culture of Legionella organisms in the lungs and spleen, titer of Legionella urinary antigen, differential cell count in bronchoalveolar lavage fluid, body weight loss, and gross inspection of the lung. Significant increases in lung Legionella concentration occurred as a result of the addition of pulmonary hilar stripping (from 105.13 + 0.34 in the thoracotomy group to 10(5.66 ± 0.25) in the thoracotomy with hilar stripping group, p = 0.013) and the addition of immunosuppression (from 105.47 + 0.47 in the isogeneic transplant group to 10(6.94 ± 0.52) in the isogeneic transplant with immunosuppression group, p = 0.00016). Thoracotomy, transplant procedures, and allogenicity itself resulted in no significant increases. The results for all other indicators paralleled those for lung culture. We conclude that the combination of drug-induced immunosuppression with lung denervation and interruption of lymphatic vessels and bronchial arteries results in the early development and increased severity of pneumonia in lung transplantation.

Original languageEnglish
Pages (from-to)449-457
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume106
Issue number3
Publication statusPublished - 1993
Externally publishedYes

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Lung Transplantation
Pneumonia
Lung
Immunosuppression
Thoracotomy
Transplants
Legionella
Bronchial Arteries
Lymphatic Vessels
Body Weight
Legionella pneumophila
General Anesthetics
Intramuscular Injections
Bronchoalveolar Lavage Fluid
Denervation
Drug Combinations
Infection
Trachea
Cyclosporine
Weight Loss

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Aeba, R., Stout, J. E., Francalancia, N. A., Keenan, R. J., Duncan, A. J., Yousem, S. A., ... Griffith, B. P. (1993). Aspects of lung transplantation that contribute to increased severity of pneumonia: An experimental study. Journal of Thoracic and Cardiovascular Surgery, 106(3), 449-457.

Aspects of lung transplantation that contribute to increased severity of pneumonia : An experimental study. / Aeba, R.; Stout, J. E.; Francalancia, N. A.; Keenan, R. J.; Duncan, A. J.; Yousem, S. A.; Burckart, G. J.; Yu, V. L.; Griffith, B. P.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 106, No. 3, 1993, p. 449-457.

Research output: Contribution to journalArticle

Aeba, R, Stout, JE, Francalancia, NA, Keenan, RJ, Duncan, AJ, Yousem, SA, Burckart, GJ, Yu, VL & Griffith, BP 1993, 'Aspects of lung transplantation that contribute to increased severity of pneumonia: An experimental study', Journal of Thoracic and Cardiovascular Surgery, vol. 106, no. 3, pp. 449-457.
Aeba, R. ; Stout, J. E. ; Francalancia, N. A. ; Keenan, R. J. ; Duncan, A. J. ; Yousem, S. A. ; Burckart, G. J. ; Yu, V. L. ; Griffith, B. P. / Aspects of lung transplantation that contribute to increased severity of pneumonia : An experimental study. In: Journal of Thoracic and Cardiovascular Surgery. 1993 ; Vol. 106, No. 3. pp. 449-457.
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AU - Aeba, R.

AU - Stout, J. E.

AU - Francalancia, N. A.

AU - Keenan, R. J.

AU - Duncan, A. J.

AU - Yousem, S. A.

AU - Burckart, G. J.

AU - Yu, V. L.

AU - Griffith, B. P.

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N2 - In lung or heart-lung transplant recipients, complications as a result of pulmonary infections continue to be the most frequent causes of morbidity and mortality. This study was undertaken to identify the contributions of (1) thoracotomy, (2) interruption of lymphatic vessels and bronchial arteries, (3) transplant procedure, (4) drug-induced immunosuppression, and (5) graft allogenicity to the increased risk of pneumonia in lung transplantation. Lewis rats were inoculated with 105 colony-forming units of Legionella pneumophila serogroup 1 by direct instillation into the trachea after one of the following: a general anesthetic with no operation; a left thoracotomy; a left thoracotomy with pulmonary hilar stripping; an isogeneic orthotopic left lung transplant with or without immunosuppression; or an allogeneic transplant with immunosuppression with Brown-Norway rats as donors. Immunosuppression was induced with an intramuscular injection of cyclosporine (25 mg/kg of body weight) from the innoculation day to day 3. All rats were killed on day 6, and severity of infection was determined by quantitative culture of Legionella organisms in the lungs and spleen, titer of Legionella urinary antigen, differential cell count in bronchoalveolar lavage fluid, body weight loss, and gross inspection of the lung. Significant increases in lung Legionella concentration occurred as a result of the addition of pulmonary hilar stripping (from 105.13 + 0.34 in the thoracotomy group to 10(5.66 ± 0.25) in the thoracotomy with hilar stripping group, p = 0.013) and the addition of immunosuppression (from 105.47 + 0.47 in the isogeneic transplant group to 10(6.94 ± 0.52) in the isogeneic transplant with immunosuppression group, p = 0.00016). Thoracotomy, transplant procedures, and allogenicity itself resulted in no significant increases. The results for all other indicators paralleled those for lung culture. We conclude that the combination of drug-induced immunosuppression with lung denervation and interruption of lymphatic vessels and bronchial arteries results in the early development and increased severity of pneumonia in lung transplantation.

AB - In lung or heart-lung transplant recipients, complications as a result of pulmonary infections continue to be the most frequent causes of morbidity and mortality. This study was undertaken to identify the contributions of (1) thoracotomy, (2) interruption of lymphatic vessels and bronchial arteries, (3) transplant procedure, (4) drug-induced immunosuppression, and (5) graft allogenicity to the increased risk of pneumonia in lung transplantation. Lewis rats were inoculated with 105 colony-forming units of Legionella pneumophila serogroup 1 by direct instillation into the trachea after one of the following: a general anesthetic with no operation; a left thoracotomy; a left thoracotomy with pulmonary hilar stripping; an isogeneic orthotopic left lung transplant with or without immunosuppression; or an allogeneic transplant with immunosuppression with Brown-Norway rats as donors. Immunosuppression was induced with an intramuscular injection of cyclosporine (25 mg/kg of body weight) from the innoculation day to day 3. All rats were killed on day 6, and severity of infection was determined by quantitative culture of Legionella organisms in the lungs and spleen, titer of Legionella urinary antigen, differential cell count in bronchoalveolar lavage fluid, body weight loss, and gross inspection of the lung. Significant increases in lung Legionella concentration occurred as a result of the addition of pulmonary hilar stripping (from 105.13 + 0.34 in the thoracotomy group to 10(5.66 ± 0.25) in the thoracotomy with hilar stripping group, p = 0.013) and the addition of immunosuppression (from 105.47 + 0.47 in the isogeneic transplant group to 10(6.94 ± 0.52) in the isogeneic transplant with immunosuppression group, p = 0.00016). Thoracotomy, transplant procedures, and allogenicity itself resulted in no significant increases. The results for all other indicators paralleled those for lung culture. We conclude that the combination of drug-induced immunosuppression with lung denervation and interruption of lymphatic vessels and bronchial arteries results in the early development and increased severity of pneumonia in lung transplantation.

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