title: Normal bronchial healing without bronchial wrapping in canine lung transplantation.
abstract: The deleterious effect of steroids on bronchial healing in lung transplantation has led to the development of techniques to protect the anastomosis and to the exclusion of steroid-dependent patients from transplantation. The effect of steroids on bronchial healing was tested in a canine single-lung allotransplantation model. Twenty size-matched mongrel dogs (20 to 30 kg) underwent left lung transplantation without anastomotic wrap or direct revascularization. Postoperatively, all received daily doses of cyclosporine (15 mg/kg) and azathioprine (1 mg/kg) and were subdivided into three steroid dosage groups. Group A (n = 10) animals received 1.5 mg/kg of prednisone per day whereas groups B (n = 5) and C (n = 5) received 5.0 mg/kg of prednisone per day for 28 postoperative days. In addition, group C received prednisone (5.0 mg.kg-1.day-1) for 1 month preoperatively. In group A, 8 of 10 dogs survived 28 days without evidence of respiratory compromise, with anastomotic bursting pressure greater than 510 mm Hg. In group B, all 5 dogs survived to 28 days without evidence of respiratory compromise and with intact bronchial anastomoses (bursting pressures greater than 510 mm Hg). In group C, 3 of 5 animals survived to 28 days with intact anastomoses. Histological examination demonstrated normal bronchial healing in all anastomoses. These data suggest that preoperative steroid dependence should not be a contraindication to lung transplantation and that bronchial anastomotic wrapping with vascular tissue may not be essential.
authors.affiliation: Department of Surgery, Columbia-Presbyterian Medical Center, New York, NY 10032.
authors.forename: J S
authors.initials: JS
authors.lastname: Auteri
authors.forename: V
authors.initials: V
authors.lastname: Jeevanandam
authors.forename: J A
authors.initials: JA
authors.lastname: Sanchez
authors.forename: C C
authors.initials: CC
authors.lastname: Marboe
authors.forename: T J
authors.initials: TJ
authors.lastname: Kirby
authors.forename: C R
authors.initials: CR
authors.lastname: Smith
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D001379:Azathioprine / Q000008:administration & dosage; D001980:Bronchi / Q000473:pathology / Q000601:surgery*; D016572:Cyclosporine / Q000008:administration & dosage; D004285:Dogs; D004848:Epithelium / Q000473:pathology; D016040:Lung Transplantation / Q000379:methods*; D011182:Postoperative Care; D011241:Prednisone / Q000008:administration & dosage; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology*
chemical_list: D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone