The Annals of Thoracic Surgery, Vol 42, 180-184, Copyright © 1986 by The Society of Thoracic Surgeons
Acute isolated pulmonary rejection following transplantation of the heart and both lungs: experimental and clinical observations
D Novitzky, DK Cooper, AG Rose and B Reichart
Early observations following transplantation of the heart and both lungs
have suggested that acute rejection occurs simultaneously in both organs.
Endomyocardial biopsy could, therefore, be used to monitor rejection in
both heart and lungs. We present here our experience with heart-lung
transplantation in the baboon, and in two recently observed human patients.
The evidence we provide suggests that acute rejection may occur earlier in
the lungs than in the heart, and that monitoring the heart alone may prove
inadequate. Of 12 baboons that survived heart and lung transplantation, 11
died from acute isolated pulmonary rejection; 10 of these 11 animals showed
no features of cardiac rejection. In 2 of 6 human patients who have
undergone this operation, an episode of acute pulmonary rejection is
believed to have occurred in the absence of cardiac rejection. There is no
easy method of confirming pulmonary rejection directly (other than
open-lung biopsy, which is clearly contraindicated as a routine procedure).
We suggest that more attention be directed toward developing tests that
indicate acute rejection but are not organ specific, rather than relying on
techniques that diagnose cardiac rejection only.
