Bronchial circulation after experimental lung transplantation: the effect of direct revascularization of a bronchial artery

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Abstract
Direct revascularization of a bronchial artery has been proposed as ameasure to alleviate the problem of bronchial ischemia after lungtransplantation. To assess the effect of restoration of arterial blood flowto the transplanted bronchus, bronchial mucosal blood flow was measured ina model of modified unilateral lung transplantation in pigs. Laser Dopplervelocimetry (LDV) and radioisotope studies using radio-labeled erythrocytes(RI) were used to measure blood flow at the donor main carina (DC) andupper lobe carina (DUC) after 3 h of reperfusion. The recipient carina wasused as a reference point; values obtained by LDV and RI were expressed aspercentage of blood flow at the recipient carina. Two groups of animalswere studied. In group 1 (n = 6) standard unilateral transplantation wasperformed; in group 2 (n = 6) a left bronchial artery was reimplanted intothe descending thoracic aorta of the recipient. No differences wereobserved between the two groups with respect to preoperative orpostoperative gas exchange or hemodynamics. In group 1, bronchial bloodflow at the DC was 37.6 +/- 2.2% (LDV) and 44.1 +/- 14.8% (RI) of referenceblood flow. At the DUC, blood flow was 54.9 +/- 7.7% (LDV) and 61.6 +/-25.7% (RI) of normal flow. In group 2, blood flow was increased at the DCas measured by LDV (55.3 +/- 17.1%; p less than 0.05) and by RI (60.8 +/-25.3%; p less than 0.2). A similar increase was found at the DUC (LDV: 81.8+/- 19.3%; p less than 0.05; RI: 88.6 +/- 31.0%; p less than 0.2). It isconcluded that there is a significant gradient of blood flow from intra- toextrapulmonary airways after lung transplantation. Reimplantation of abronchial artery results in significant improvement of graft bronchialblood flow. Restoration of bronchial perfusion to normal levels, however,cannot be achieved, suggesting a possible defect in the microcirculation ofthe donor airways.

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