Pulmonary infection defense after lung transplantation: does airway ischemia play a role?
OBJECTIVE
During a classical lung transplantation procedure, there is no attempt to restore the bronchial circulation, giving rise to ischemia of the mucosa with initial loss of ciliated function. This might compromise the ciliary function and the infection defense mechanisms of the airways.


RESULTS
Although initially the airways are characterized by ischemia (epithelial sloughing), later on, there seems to be a restoration of the ciliary function and up to now, there is no clear evidence that there is an increased risk of infectious episodes due to the lack of bronchial circulation, although this has not extensively been investigated.


CONCLUSIONS
Local pulmonary defense mechanisms after lung transplantation without bronchial revascularization seem to be preserved at least in a stable condition. Whether the loss of bronchial circulation has a negative impact when complications develop (such as bronchiolitis obliterans syndrome) remains speculative.
Verleden
Geert M
GM
Lung Transplantation Unit and Laboratory, University Hospital Gasthuisberg, Leuven, Belgium. geert.verleden@uzleuven.be
Vos
Robin
R
van Raemdonck
Dirk
D
Vanaudenaerde
Bart
B
D000714:Anastomosis, Surgical; D000818:Animals; D001981:Bronchial Arteries / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D002923:Cilia / Q000473:pathology; D002925:Ciliary Motility Disorders / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008168:Lung / Q000098:blood supply* / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D011652:Pulmonary Circulation; D015427:Reperfusion Injury / Q000209:etiology* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D020545:Respiratory Mucosa / Q000473:pathology / Q000503:physiopathology; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome
D018836:Inflammation Mediators