Donor selection for single and double lung transplantation. Chest size matching and other factors influencing posttransplantation vital capacity

In six single lung transplant (SLT) and six double lung transplant (DLT) recipients, the relationships of the recipient's posttransplantation vital capacity (posttx VCR) to the recipient's predicted normal vital capacity (pred VCR) and the donor's predicted normal vital capacity (pred VCD) were investigated. After left SLT the left posttx VCR was correlated with the left predicted VCD (r = 0.83; p less than 0.05); however, no correlation was found between these after DLT. In contrast, there was a tendency toward correlation between the posttx VCR and the predicted VCR after DLT (r = 0.75; p less than 0.1), but no such trend was apparent after SLT. These results suggest that posttx VCR depends primarily on predicted VCD after SLT and on pred VCR after DLT. Therefore, in donor-recipient size matching for lung transplantation a donor with a pred VCD greater than the pred VCR should be chosen for a left SLT recipient, whereas a donor with a pred VCD near the pred VCR would be suitable for a DLT recipient.

Synthesis of alpha-D-Manp-(1----3)-[beta-D-GlcpNAc-(1----4)]-[alpha-D-Manp+ ++-(1----6)] - beta-D-Manp-(1----4)-beta-D-GlcpNAc-(1----4)-[alpha-L-Fucp- (1----6)]-D- GlcpNAc, a core glycoheptaose of a "bisected" complex-type glycan of glycoproteins

A synthesis of alpha-D-Manp-(1----3)-[beta-D-GlcpNAc-(1----4)]-[alpha-D-Manp++ +-(1----6)]- beta-D-Manp-(1----4)-beta-D-GlcpNAc-(1----4)-[alpha-L-Fucp-( 1----6)]-D- GlcpNAc was achieved by employing benzyl O-(3,4,6-tri-O-benzyl-2-deoxy-2-phthalimido-beta-D-glucopyranosyl)-(1--- -4)-O- (2-O-benzyl-beta-D-mannopyranosyl)-(1----4)-O-(3,6-di-O-benzyl-2-deoxy-2 - phthalimido-beta-D-glucopyranosyl)-(1----4)-3-O-benzyl-2-deoxy-6-O-p- methoxyphenyl-2-phthalimido-beta-D-glucopyranoside as a key glycosyl acceptor. Highly stereoselective mannosylation was performed by taking advantage of the 2-O-acetyl group in the mannosyl donors. The alpha-L-fucopyranosyl residue was also stereoselectively introduced by copper(II)-mediated activation of methyl 2,3,4-tri-O-benzyl-1-thio-beta-L-fucopyranoside.

Synthesis of an appropriately protected core glycotetraoside, a key intermediate for the synthesis of "bisected" complex-type glycans of a glycoprotein

A stereocontrolled synthetic route to a glycotetraoside, allyl O-(3,4,6-tri-O-benzyl-2-deoxy-2-phthalimido-beta-D-glucopyranosyl)-(1--- -4)-O- (3,6-di-O-allyl-2-O-benzyl-beta-D-mannopyranosyl)-(1----4)-O-3, 6-di-O-benzyl-2-deoxy-2-phthalimido-beta-D-glucopyranosyl)-(1----4)-3-O- benzyl- 2-deoxy-6-O-p-methoxy-phenyl-2-phthalimido-beta-D-glucopyranoside, an important intermediate for the synthesis of "bisected" complex type glycans of glycoproteins has been established by employing two glycosyl donors, 3,4,6-tri-O-benzyl-2-deoxy-2-phthalimido-beta-D-glucopyranosyl trichloroacetimidate and 4-O-acetyl-3,6-di-O-allyl-2-O-benzyl-alpha-D-mannopyranosyl bromide, and a glycosyl acceptor, allyl O-(3,6-di-O-benzyl-2-deoxy-2-phthalimido-beta-D-glucopyranosyl)-(1----4) -3-O- benzyl-2-deoxy-6-O-p-methoxyphenyl-2-phthalimido-beta-D-glucopyranoside.

A regio- and stereo-controlled synthesis of beta-D-Glcp NAc6SO3-(1----3)-beta-D-Galp6SO3-(1----4)-beta-D-GlcpNAc 6SO3- (1----3)-D-Galp, a linear acidic glycan fragment of keratan sulfate I

A stereocontrolled synthesis of beta-D-GlcpNAc6SO3-(1----3)-beta-D-Galp6SO3-(1----4)-beta-D- GlcpNAc6SO3- (1----3)-D-Galp, was achieved by use of benzyl O-(2-acetamido-3,4 di-O-benzyl-2-deoxy-6-O-p-methoxyphenyl-beta-D- glucopyranosyl)-(1----3)-O-(2,4-di-O-tert-butyldiphenylsilyl-beta- D- galactopyranosyl-(1----4)-O-(2-acetamido-3-O-benzyl-2-deoxy-6-O-p-methox yphenyl - beta-D-glucopyranosyl)-(1----3)-2,4,6-tri-O-benzyl-beta-D-galactopyranos ide as a key intermediate, which was in turn prepared by employing two glycosyl donors, 3,4-di-O-benzyl-2-deoxy-6-O-p-methoxyphenyl-2-phthalimido-beta-D- glucopyranosyl trichloroacetimidate and O-(3,6-di-O-acetyl-2,4-di-O-benzyl-beta-D-galactopyranosyl)-(1----4)-3-O - benzyl-2-deoxy-6-O-p-methoxyphenyl-2-phthalimido-beta-D-glucopyranosyl trichloroacetimidate, and a glycosyl acceptor, benzyl 2,4,6-tri-O-benzyl-beta-D-galactopyranoside.

The effect and optimal time of administration of verapamil on lung preservation

Calcium channel blockers have recently been shown to improve pulmonary and myocardial preservation. The effect of verapamil on hypothermic lung preservation was investigated using an isolated ventilated rabbit lung perfusion model. In phase 1, preserved lungs were not flushed prior to extraction. Four groups of five animals were studied: group 1 (no verapamil), group 2 (verapamil administration prior to extraction), group 3 (verapamil at reperfusion only), group 4 (verapamil both prior to extraction and at reperfusion). In phase 2, two groups of five animals received pulmonary artery flush with low potassium (4 mmol/L), 2% low-potassium dextran (LPD) solution; group 1 (without verapamil), group 2 (flush and reperfusion with verapamil). As in phase 1, lungs were stored for 30 hr at 10 degrees C prior to reperfusion. In phase 3, the protocol was identical to phase 2, except that the storage time was extended to 48 hr. PO2 (mean +/- SE) of effluent blood in lungs treated with verapamil prior to extraction (122.8 +/- 5.0 mmHg) was significantly increased in comparison with lungs not receiving verapamil (69.0 +/- 3.3 mmHg) or only receiving verapamil at the time of reperfusion (87.1 +/- 11.9 mmHg). Gas exchange after 30 hr storage was equivalent in lungs flushed with LPD with or without verapamil. However verapamil did provide an advantage when preservation times were extended to 48 hr (62.3 +/- 8.5 mmHg, 46.9 +/- 2.3 mmHg). Verapamil administered prior to lung extraction provides better lung function following preservation, but has benefit over LPD flush only with extended periods of preservation (48 hr).

Radiologic correlation with early physiologic function of the transplanted canine lung

There is no single reliable method for assessment of the transplanted lung. Multiple modes of assessment are therefore used. In a canine model designed to assess lung preservation, the reliability of information gained from chest radiographs performed in the early post-transplant period was examined. The function of 20 left lung allografts, stored for 12 hours after pulmonary artery flush preservation was studied. Radiographs graded according to disease severity were compared with physiologic function of the transplanted lung assessed immediately and at three days post-transplantation. This protocol enables study of acute preservation-related lung injury and the delayed manifestations of ischemic and reperfusion injury after a three day period of recovery, while avoiding confounding rejection and infectious episodes. The chest radiograph did not reliably reflect function of the flush-preserved transplanted lung. Thus, relying only on this modality may lead to erroneous conclusions. In this study, the progression of radiographic changes associated with the "reimplantation response" differed from previous descriptions, possibly reflecting differences in operative technique or improved lung preservation.

The superiority of an extracellular fluid solution over Euro-Collins' solution for pulmonary preservation

Limited donor supply is the major factor restricting the application of lung transplantation. A uniformly reliable method of lung preservation would improve donor organ availability. At present, Euro-Collins' solution, an intracellular fluid-type solution, is most widely used in organ preservation. However, we have previously shown that initial pulmonary flush with an extracellular-type solution (low-potassium dextran solution [LPD]) provided better pulmonary preservation than Euro-C. In the present study, we used an in vitro-ventilated, blood-perfused rabbit lung model to examine whether the mechanism for this improvement was related to the effect of LPD during pulmonary flush or its effect during storage. Rabbit lungs were harvested and stored after pulmonary flush with different solutions (group 1: 400 ml of LPD; group 2: 400 ml of Euro-C; group 4: 300 ml of Euro-C followed by 100 ml of LPD; n = 5 in each group). The lungs were then preserved at 10 degrees C for 18 hr and reperfused with fresh venous blood. After 10 min of reperfusion, lungs in group 1 showed the highest PO2 (group 1: 124.4 +/- 7.7 mmHg; group 2: 46.2 +/- 9.4 mmHg P less than 0.01). Lungs in both group 3 and group 4 showed better lung function and lower wet/dry weight ratio than those in group 2. We conclude that LPD provides better lung preservation by its effects both on pulmonary flush and on storage.

Structure and Function of a Special Tissue in the Female Genital Ducts of the Chinese Freshwater Crab Eriocheir sinensis

The histological anatomy of the genital ducts of adult females of Eriocheir sinensis was studied before and after copulation, and during and after egg-laying. A strongly basophilic valve-like tissue was discovered at the junction of the spermatheca and the oviduct. This tissue prevents communication between the spermatheca and the oviduct except during oviposition. At this time, it functions as a valve, allowing ripe eggs out of the oviduct and preventing sperm from entering the oviduct during and after egg-laying. These findings suggest that the actual site of gamete contact in E. sinensis is within the spermatheca, instead of in the lumen of the ovary or in the oviduct. The presence of the valve-like tissue assures that the ripe eggs collected from the ovary during egg-laying are unfertilized. This observation is of great importance for obtaining unfertilized ripe eggs in studies of artificial fertilization (in vitro) and hybridization. The valve-like tissue has not been described in other brachyurans, and this genital duct should be classified as new for the Brachyura.

Evaluation of a bronchial anastomosis by laser Doppler velocimetry

Healing after bronchoplasty was evaluated by assessing the bronchial mucosal blood flow by laser Doppler velocimetry in dogs. Bronchoplastic surgery at the right main bronchus was performed and bronchial mucosal blood flow was determined by laser Doppler velocimetry at proximal and distal sides of the anastomosis before and after operation. Four experimental groups were established. After operation the blood flow was adequately preserved, and healing of the anastomosis site was satisfactory in the minimum detachment group and steroid-treated group. Mucosal blood flow was markedly reduced in both proximal and distal sides in the extensive detachment group. The extent of the reduction in the blood flow was smaller in the omentum dressing group than in the extensive detachment group. The state of healing of the anastomosis site was closely related to the bronchial mucosal blood flow.

A method for safe twelve-hour pulmonary preservation

The clinical application of lung transplantation is severely limited by the shortage of suitable donor organs. Current techniques of lung preservation allow a maximum of 4 to 6 hours of safe ischemic time. The function of canine left lung allografts stored for 12 hours after being cooled by pulmonary artery flush was studied. Two types of flush solution were used: group I; Euro-Collins solution; group II, low-potassium-dextran solution. Lung function was studied immediately and 3 days after transplantation. This protocol enables study of acute preservation-related lung injury and the delayed manifestations of ischemic and reperfusion injury after a 3-day period of recovery. Inflatable cuffs were placed around each pulmonary artery at operation and were attached to subcutaneous injection ports. Temporarily occluding either pulmonary artery allowed independent study of the native or transplanted lung. Using this model, we were able to demonstrate reliable and reproducible preservation of lungs for 12 hours. The low-potassium-dextran solution provided significantly better immediate function of the preserved lung than the Euro-Collins solution: arterial oxygen tension 509 +/- 15 mm Hg versus 111 +/- 16 mm Hg (p less than 0.0001). Function on the third day was excellent for both groups. Pulmonary artery pressure, pulmonary vascular resistance, and carbon dioxide tension were not significantly different between the groups immediately or on day 3.

Application of laser Doppler velocimetry to lung transplantation

The relationship between healing of a bronchial anastomosis and regional blood flow was studied in adult mongrel dogs after allotransplantation of the left lung. Animals were divided into the following three groups according to the immunosuppressive regimen. Group A: no immunosuppressive treatment (n = 7); Group B: azathioprine (5 mg/kg/day) and prednisolone (2 mg/kg/day) (n = 4); Group C: cyclosporine (20 mg/kg/day) (n = 4). The mucosal blood flow was examined serially after transplantation with laser Doppler velocimetry (LDV) at the tracheal bifurcation of the recipient (1st LDV) and at the bifurcation of the upper lobe bronchus of the transplanted lung (2nd LDV). The LDV values were expressed as a ratio to the preoperative values at the same site. Healing of the bronchial anastomosis was also assessed macroscopically with a fiberoptic bronchoscope and microscopically. The 2nd LDV value of the animals in group A at 13 days after transplantation remained low (32.9 +/- 27.6%). The 2nd LDV value in group B, although not significantly different from group A, had recovered to the preoperative level by that time (93.7 +/- 23.4%). By contrast, the 2nd LDV value in group C remained significantly higher than that in group A (119.9 +/- 23.0%, P less than 0.05). The 1st and 2nd LDV values were reduced in animals having infection at the bronchial anastomosis, even those in groups B and C. Bronchial mucosal blood flow appeared to be affected by infection and rejection of the transplanted lung, and to correlate closely with the healing of the bronchial anastomosis. This LDV method is useful to evaluate bronchial mucosal blood flow in experimental, and possibly in clinical, fields.

The effect of ischemic time and temperature on lung preservation in a simple ex vivo rabbit model used for functional assessment

Despite 25 years of research in lung transplantation, little progress has been made in methods for improving lung preservation. To evaluate many factors that may affect lung function after preservation, we have developed a simple, reliable, and inexpensive animal model. This consists of an isolated rabbit lung preparation perfused with blood and ventilated with a closed-circuit system. Heart-lung blocks were harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. On completion of a storage period, the left lung was ventilated and perfused with fresh rabbit venous blood at a rate of 40 ml/min for 10 minutes. Assessment of lung function included gas analysis of infused and effluent blood, oxygen uptake, mean pulmonary artery perfusion pressure, and mean airway pressure. A control group and six preservation groups were evaluated, each with different storage temperatures (38 degrees C, 34 degrees C, 23 degrees C, 15 degrees C, 10 degrees C, and 4 degrees C). For each temperature, ischemic periods ranging from 1 to 30 hours were studied. In the control group, the lungs were assessed immediately after being harvested. In the preservation groups, the lungs were kept partially inflated, stored at a predetermined temperature by immersion, and later assessed after variable ischemic periods. Our studies demonstrated the following: (1) The degree of impaired lung function produced by ischemia is reflected by a decrease in oxygen uptake and in oxygen tension of the effluent pulmonary venous blood and an increase in pulmonary artery perfusion pressure; (2) hypothermia improves ischemic tolerance; (3) preservation of lung at 10 degrees C is superior to preservation at 15 degrees C and 4 degrees C. This screening model has allowed evaluation of independent multiple factors and methods pertinent to lung preservation and enables one to assess lung function reliably and rapidly.

An evaluation of the tolerance of the autotransplanted canine lung against warm ischemia

Left lung autotransplantation was performed in mongrel dogs to examine the limitation of tolerance of the deflated lung against warm ischemia in a warm ischemic time (WIT) range of 60-360 minutes. The animals were divided into the 4 following groups according to the duration of WIT and the use of heparin: Group 1; WIT 60-120 min., heparin (-), Group 2; WIT 120-240 min., heparin (+), Group 3; WIT 240-360 min., heparin (+), and Group 4; WIT 240-360 min., heparin (-). All the Group 1 animals tolerated a right pulmonary artery ligation on the 6th postoperative day, but some of the Group 2 animals died immediately after the reimplantation due to pulmonary edema. All the Groups 3 and 4 animals died. The PaO2 values during the right pulmonary artery occlusion, immediately after the reimplantation, correlated well with the survival of the animals. The maximum tolerable WIT of the deflated dog lung was considered to be 120 minutes.

[Technical problems on right lung transplantation]

This report describes the technique of the allo-transplantation of the right lung of an adult mongrel dog. Compare to the transplantation of the left lung, we found several pitfalls in the right lung transplantation. 1) The intraatrial groove of the recipient must be divided carefully just at the middle of the right and the left atrium in order to make a generous cuff for the left atrial anastomosis. 2) It is preferable to divide azygos vein to perform easy anastomosis of right pulmonary artery and right bronchus. 3) Care must be taken to make left atrial cuff in donor lung since we did not divide intraatrial groove in the donor animal. It was necessary to make the left atrial cuff with a part of the right atrium attached.

[Histological observations of immunosuppressive effects of FK-506 in canine lung allotransplantation]

The Immunosuppressive effects of FK-506 were studied histologically in allotransplanted canine lungs. FK-506 was administered daily in a dose of 0.15 mg/kg after left lung allotransplantation. Nine dogs underwent open lung biopsy on the 7th postoperative day (p.o.d.). Mild mononuclear cell infiltrations around small vessels (MNC cuffings), which suggested an early phase of rejection, were observed in 2 dogs. Two dogs were sacrificed on the 14th and 2 on the 21st p.o.d. MNC cuffings were observed in the lung of one dog and in the bronchial submucosa of 2 dogs. Six dogs were sacrificed on the 28th p.o.d. MNC cuffings were observed in the lungs of 3 dogs and in the bronchial submucosa of 5 dogs. The MNC cuffings were of nearly the same extent in the lung and in the bronchial submucosa of most of the dogs. Alveolar structures were well in all the dogs and the bronchial epithelium in all except 2 of the dogs sacrificed on the 28th p.o.d. preserved. Arterial blood gas was examined before and 20 min. after right hilar ligation in 3 dogs on the 28th p.o.d. The PaO2 (228 mmHg, 312 mmHg, 217 mmHg at FiO2: 0.5, tidal volume: 20 ml/kg, respiratory rate: 20/min) and PaCO2 after rt, hilar ligation indicated that the transplanted lung was functioning well in these dogs. The present study suggests that FK-506 could be a potent immunosuppressive agent in lung transplantation. As 4 of the 14 dogs used in this experiment died from severe diarrhea caused by FK-506, further studies are needed to determine the suitable dose and route of administration of FK-506.

Familial multiple neurilemoma. A case report

A case of familial multiple neurilemoma is reported. A 59-year-old man with five neurilemomas was treated. Fifteen of his 22 family members had had soft-tissue tumors. Ten neurilemomas had been diagnosed microscopically in five members of the family. There were no symptoms related to von Recklinghausen's disease. This case seems to be a forme fruste or related form of von Recklinghausen's disease.

Mechanism of interferon-gamma action. Characterization of indoleamine 2,3-dioxygenase in cultured human cells induced by interferon-gamma and evaluation of the enzyme-mediated tryptophan degradation in its anticellular activity

Induction by interferon-gamma of indoleamine 2,3-dioxygenase (a tryptophan degradation enzyme) was examined with 11 human cell lines. The enzyme induction was demonstrated in 7 of the 11 cell lines. The induced enzyme in each of the 7 cell lines was identical to the enzyme purified from human placenta, as evidenced by immunoblot analysis with a monoclonal antibody specific to the placental one. The extent of the induction varied largely with the cell line; a relatively high induction was observed with HEL (lung fibroblasts), NY (osteosarcoma), and A-431 (epidermoid carcinoma). The enzyme induction was dependent on the concentration of interferon-gamma and occurred 12-18 h after addition of interferon-gamma to the cultures. Interferon-alpha or -beta was completely ineffective in this induction. Interferon-gamma inhibited the growth of the 7 cell lines observed with the enzyme induction, and this growth inhibition was accompanied with a complete deletion of tryptophan (less than 1 microM) in the culture medium by the induction of the enzyme. For two of these cell lines, the inhibition was partially reversed by an addition of exogenous tryptophan to the medium not to be depleted. These findings indicated that the growth inhibition by interferon-gamma was in part explained by the tryptophan depletion in the medium caused by the enzyme induction.