Binns O A, DeLima N F, Buchanan S A, Lopes M B, Cope J T, Marek C A, King R C, Laubach V E, Tribble C G, Kron I L
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville, USA.
J Thorac Cardiovasc Surg. 1997 Aug;114(2):186-94. doi: 10.1016/S0022-5223(97)70143-0.
Mature lobar transplantation will increase the pediatric donor organ pool, but it remains unknown whether such grafts will grow in a developing recipient and provide adequate long-term support. We hypothesized that a mature pulmonary lobar allograft implanted in an immature recipient would grow.
We investigated our hypothesis in a porcine orthotopic left lung transplant model using animals matched by the major histocompatibility complex to minimize the effects of chronic rejection. Twenty-three immature animals (< 12 weeks of age and < 10 kg total body weight) received either sham left thoracotomy (SH control, n = 4), left upper lobectomy to study compensatory growth (UL control, n = 4), age-matched immature whole left lung transplants (IWL TXP, n = 6), mature (donor > 1 yr in age and > 40 kg in total body weight) left lower lobe transplants (MLL TXP, n = 5), or mature left upper lobe transplants (MUL TXP, n = 4). Twelve weeks after implantation, functional residual capacity of the left lung was measured and arterial blood gas samples were obtained after the native right lung had been excluded. The graft was excised and weighed, and samples for microscopy and wet/dry ratios were collected.
Initial and final graft weights were as follows: IWL TXP group (34.6 +/- 1.5 and 107.8 +/- 5.9 gm, p < 0.0001), MLL TXP group (72.4 +/- 6.8 and 111.4 +/- 8.7, p < 0.001), and MUL TXP group (32.8 +/- 1.3 and 92.8 +/- 7.1 gm, respectively, p < 0.004). No significant differences between groups were demonstrated when functional residual capacity, wet/dry ratios, or oxygenation were compared. Immunohistochemical staining for the nuclear antigen Ki-67 demonstrated dividing pneumocytes.
We conclude that a mature lobar graft implanted into an immature recipient grows by pneumocyte division in this model. Mature lobar transplants can be expected to grow and provide adequate long-term function in developing recipients.
成熟肺叶移植将增加儿科供体器官库，但此类移植物在发育中的受体中是否会生长并提供足够的长期支持仍不清楚。我们假设植入未成熟受体的成熟肺叶同种异体移植物会生长。
我们在猪原位左肺移植模型中研究了这一假设，使用主要组织相容性复合体匹配的动物以尽量减少慢性排斥反应的影响。23只未成熟动物（年龄<12周且总体重<10千克）接受了以下处理：假左胸切开术（SH对照组，n = 4）、左上肺叶切除术以研究代偿性生长（UL对照组，n = 4）、年龄匹配的未成熟全左肺移植（IWL TXP，n = 6）、成熟（供体年龄>1岁且总体重>40千克）左下肺叶移植（MLL TXP，n = 5）或成熟左上肺叶移植（MUL TXP，n = 4）。植入后12周，测量左肺的功能残气量，并在排除天然右肺后采集动脉血气样本。切除移植物并称重，收集用于显微镜检查和湿/干比的样本。
初始和最终移植物重量如下：IWL TXP组（34.6±1.5和107.8±5.9克，p<0.0001），MLL TXP组（72.4±6.8和111.4±8.7，p<0.001），MUL TXP组（分别为32.8±1.3和92.8±7.1克，p<0.004）。比较功能残气量、湿/干比或氧合时，各实验组间无显著差异。核抗原Ki-67的免疫组织化学染色显示有增殖的肺细胞。
我们得出结论，在该模型中，植入未成熟受体的成熟肺叶移植物通过肺细胞分裂生长。可以预期成熟肺叶移植在发育中的受体中会生长并提供足够的长期功能。
