From Big Medical Encyclopedia

CHANGE OF THE LUNG (synonym transplantation of a lung) — substitution at the recipient of a lung or a lung lobe a transplant from the donor. Distinguish also autotransplantation — operation of change of own previously removed lung or its share. Change of a lung did not come out the period of experimental studying since its legal bases, many technical and immunological aspects are not solved.

The first attempt of transplantation of a lung lobe in an experiment was made by the Soviet scientist V. P. Demikhov in 1947 B. V. Petrovsky, M. Perelman, Yu. Ya. Rabinovich (1975) allocate three periods in P.'s studying to l. The first period (1950 — 1960) — the period of studying of an opportunity hallo - and autotransplantations of a lung in an experiment on animals. The second period (1961 — 1970) covers works on an in-depth study of all problem P. of l. on big groups of animals, especially on technology of operation, preservation of a lung, recovery morfol, structures of a transplantirovanny lung, to methods of immunodepressantny therapy. In the third period (after 1970) improvement of the technology of operation on various animals continues (including and monkeys), the methods of long preservation of a lung promoting achievement of the best results of P. of l develop. in an experiment and clinic.

Wide-ranging studies on autotransplantation of a lung in an experiment allow to study preservation of a lung and difficult morfol., fiziol, and surgical questions P. of l. in the conditions of histocompatibility. It is established that recovery of ways of a lymph drainage in an autotransplantirovanny lung begins in 7 — 8 days after operation, blood circulation on system of bronchial arteries — in 10 — 15 days, and innervations — in 4 — 6 months. In view of absence in such lung of a reflex of Goering — Breyer (the respiratory reflex from mechanioreceptors of lungs arising at stretching and a pulmonary collapse during each respiratory act and also during the passing of air on pneumatic ways) adaptive reactions of the device of external respiration are provided with reflexes of proprioceptors of respiratory muscles of a chest wall and humoral factors.

the Diagrammatic representation of orthotopical autotransplantation of the lower share of the right lung to the place of a remote left lung: and — in the right lung the lower share is shaded, the line of crossing of the right lower lobar bronchus is designated by a dotted line; the left lung (shading in a cell) is prepared for removal, the line of crossing of the left primary bronchus is designated by a dotted line; — in the right lung upper and average shares are straightened; at the left — transplantation of the lower share of the right lung to the place of a remote left lung is finished, the line of seams on a primary bronchus is specified.

Consecutive bilateral autotransplantation of lungs, orthotopical autotransplantation of the lower share of the right lung to the place of remote left easy (fig.) are successfully performed.

In a wedge, practice of E. N. Meshalkin (1962 — 1964) made an attempt of autotransplantation of a lung for the purpose of its denervation at patients with bronchial asthma. Studying of the immediate and long-term results of this operation showed that it is dangerous and difficult and does not solve a problem of operational treatment of bronchial asthma.

At the same time in some countries P.'s attempts were made by l. in clinical practice. First P. of l. the clinic executed J. Hardy et al. (1963). By 1980 it was known of 40 made operations. Obstructive emphysema, a pneumofibrosis, a pneumoconiosis and others bilateral hron, the progressing diseases of lungs, in some cases — primary pulmonary hypertensia, an injury of a lung, a tumor were indications to operation most often.

Before transplantation make typing on erythrocyte, leukocytic and other antigens. The lung for change is taken from the donor at so-called brain death (in the countries where it is legalized) that is inadmissible in the USSR and some other countries where capture of bodies only after true (biological) death is authorized. For preservation the lung is cooled at t ° 4 °, having placed it in the refrigerator, or carry out perfusion (see) in the conditions of a hypothermia. Term between capture of a lung at the donor and his inclusion in a blood stream of the recipient shall be perhaps shorter.

Main stages of operation P. of l. imposing of a venous anastomosis, anastomosis of a pulmonary artery and a primary bronchus are. For the purpose of simplification of imposing of an anastomosis the donor lung is taken with the longest pieces of the main vessels and a bronchial tube; it is better to cut pulmonary veins together with the site of a wall of the left auricle.

After P. of l. carry usually out the prolonged artificial ventilation (see. Artificial respiration ), immunodepressantny therapy by an imuran (Azathioprinum), corticosteroid hormones, anti-lymphocytic serum, Actinomycinum With (see. Immunotherapy ). Appoint high doses of antibiotics.

The vast majority of the operated patients died within the first month after operation. The main reasons for death were respiratory insufficiency (see) and inf. complications. Pathoanatomical usually reveal reaction of rejection of the replaced lung (see. Incompatibility immunological ) and pneumonia, to-ruyu it is difficult to distinguish from atypical reaction of rejection. Only one patient at the age of 23 years whom operated in 1968 with F. Derom lived after operation of 10 months; death came from respiratory insufficiency owing to the progressing reaction of rejection.

P.'s possibility of l. it is in the future directly connected with preliminary definition of histocompatibility, improvement of preservation of a donor organ, prevention of reaction of rejection.

See also Transplantation (bodies and fabrics) .

Bibliography: Meshalkin E. N and And l of feli e r and N of JI. Ya. Various methods of denervation of lungs in surgeries of bronchial asthma, Tashkent, 1978, bibliogr.; Petrovsky B. V., Perel of ý-m and M. I. N and P and both N about in and the p Yu. Ya. Autotransplantation of a lung in an experiment, M., 1975, bibliogr.; In e n f i e 1 d J. R. Lung transplantation, past, present and future, J. Jap. Ass. thorae. Surg., v. 23, p. 1 145, 1975; Blumenstock D. Lung transplantation update, Transplant. Proc., v. 9, p. 1641, 1977, bibliogr.; <Hardy 3. D. a. o. A case of clinical lung allotransplantation, J. thorae. cardiovasc. Surg., v. 00, p. 411, 1970; Veith F. J. a. Iv o e r n e of S. K. Lung transplantation 1977, Wid J. Surg., v. 1, p. 177, 1977.

M. I. Perelman.