Advertisement

Pathology of Heart—Lung Transplantation

  • S. A. Yousem

Abstract

With over 250 heart—lung transplantations performed worldwide, a clinical management scheme for these patients has emerged1. Clinicians specializing in heart—lung allografting have established consistent, reproducible data utilizing radiographic, immunologic, and pulmonary function information, which allow the identification of lung rejection or interposed infectious processes. Coinciding with this clinical progression, a reproducible, consistent pattern of histopathologic changes has been identified, which allows the diagnosis of both acute and chronic lung rejection2–9.

Keywords

Lung Transplantation Adult Respiratory Distress Syndrome Bronchial Artery Bronchiolitis Obliterans Diffuse Alveolar Damage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kaye, M.P. (1987). The Registry of the International Society for Heart Transplantation: fourth official report — 1987. J. Heart Transplant., 6, 191PubMedGoogle Scholar
  2. 2.
    Yousem, S., Burke, C. and Billingham, M. (1985). Pathologic pulmonary alterations in long-term human heart—lung transplantation. Hum. Pathol., 16, 911PubMedCrossRefGoogle Scholar
  3. 3.
    Tazelaar, H.D. and Yousem, S. (1989). Heart-lung transplantation: an autopsy study. Hum. Pathol., 19, 1403CrossRefGoogle Scholar
  4. 4.
    Veith, F., Sinha, S., Blumcke, S., Dougherty, J.C., Becker, N.H., Siegelman, S.S. and Hagstrom, J.W. (1972). Nature and evolution of lung allograft rejection with and without immunosuppression. J. Thorac. Cardiovasc. Surg., 63, 509PubMedGoogle Scholar
  5. 5.
    Halasz, N., Cantanzaro, A., Trummer, M., Tisi, G.M., Saltzstein, S.L., Moser, K.M. and Hutchin, P. (1973). Transplantation of the lung: correlation of physiologic, immunologic and histologic findings. J. Thorac. Cardiovasc. Surg., 66, 581PubMedGoogle Scholar
  6. 6.
    Byers, J., Sabanayagam, P., Zarins, C., Baker, R.R. and Hutchins, G.M. (1973). Pathologic changes in baboon lung allografts. Ann. Surg., 178, 754PubMedCrossRefGoogle Scholar
  7. 7.
    Baker, R., Sabanayagam, P., Zarins, C., James, A.E., Hutchins, G.M., Byers, J.M., Katarajan, T.K. and Lee, J.M. (1973). Functional and morphologic changes after lung allografting in baboons. Surg. Gynecol. Obstet., 137, 650PubMedGoogle Scholar
  8. 8.
    Joseph, W. and Morton, D. (1971). Morphologic alterations in the transplanted primate lung. Surg. Gynecol. Obstet., 133, 821PubMedGoogle Scholar
  9. 9.
    Veith, F., Kamholz, S., Mollenkoph, F. and Montefusco, C. (1983). Lung transplantation, 1983. Transplantation, 35, 271PubMedCrossRefGoogle Scholar
  10. 10.
    Veith, F., Koerner, S., Siegelman, S., Kawakami, M., Kaufman, S., Attai, L.A., Hagstrom, J.W. and Gliedman, M.L. (1973). Diagnosis and reversal of rejection in experimental and clinical lung allografts. Ann. Thorac. Surg., 16, 172PubMedCrossRefGoogle Scholar
  11. 11.
    Veith, F. and Hagstrom, J. (1972). Alveolar manifestations of rejection: an important cause of the poor results with human lung transplantation. Ann. Surg., 175, 336PubMedCrossRefGoogle Scholar
  12. 12.
    Veith, F J., Norin, A. J., Montefusco, C.M., Pinsker, K.L., Kamholz, S.L., Sliedman, M.L. and Emeson, E. (1981). Cyclosporin-A in experimental lung transplantation. Transplantation, 32, 474PubMedCrossRefGoogle Scholar
  13. 13.
    Burke, C.M., Theodore, J., Baldwin, J.C., Tazelaar, H.D., Morris, A.J., McGrego, C., Shumway, N.E., Robin, E.D. and Jamieson, S.W. (1986). Twenty-eight cases of human heart—lung transplantation. Lancet, 1, 517PubMedCrossRefGoogle Scholar
  14. 14.
    Griffith, B.P., Hardesty, R.L., Trento, A, Paradis, I., Duquesnoy, R.J., Zeevi, A., Dauber, J.H., Dummer, J.S., Thompson, M.E., Gryzan, S. and Bahnson, H.T. (1987). Heart-lung transplantation: lessons learned and future hopes. Ann. Thorac. Surg., 43, 6PubMedCrossRefGoogle Scholar
  15. 15.
    Burke, C., Theodore, J., Dawkins, K., Yousem, S.A., Blank, N., Billingham, M.E., van Kessel, A., Jamieson, S.W., Oyer, P.E., Baldwin, J.C., Stinson, E.B., Shumway, N.E. and Robin, E.D. (1984). Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart—lung transplantation. Chest, 86, 824PubMedCrossRefGoogle Scholar
  16. 16.
    Prop, J.M., Ehrie, M.G., Crapo, J.D., Nieuwenhuis, N.C.P. and Wildevuur, C.R.H. (1984). Reimplantation response in isografted rat lungs. J. Thorac. Cardiovasc. Surg., 87, 702PubMedGoogle Scholar
  17. 17.
    Reitz, B. (1982). Heart-lung transplantation: a review. Heart Transplant., 1, 291Google Scholar
  18. 18.
    Jamieson, S., Baldwin, J., Stinson, E, Reitz, B.A., Oyer, P.E., Hunt, S., Billingham, M., Theodore, J., Modry, D. and Bieber, C.P. (1984). Clinical heart—lung transplantation. Transplantation, 37, 81PubMedCrossRefGoogle Scholar
  19. 19.
    Prop, J.M., Wildevuur, C.R.H. and Nieuwenhuis, P. (1985). Lung allograft rejection in the rat. III. Corresponding morphological rejection phases in various rat strain combinations. Transplantation, 40, 132PubMedCrossRefGoogle Scholar
  20. 20.
    Prop, J., Nieuwenhuis, P. and Wildevuur, C.R.H. (1985). Lung allograft rejection in the rat. I. Accelerated rejection caused by graft lymphocytes. Transplantation, 40, 25PubMedCrossRefGoogle Scholar
  21. 21.
    Prop, J.M., Wildevuur, C.R.H. and Nieuwenhuis, P. (1985). Lung allograft rejection in the rat. II. Specific immunological properties of lung grafts. Transplantation, 40, 126PubMedCrossRefGoogle Scholar
  22. 22.
    Novitzky, D., Cooper, D.K.C., Rose, A.G. and Reichart, B. (1986). Acute isolated pulmonary rejection following transplantation of the heart and both lungs: experimental and clinical observations. Ann. Thorac. Surg., 42, 180.PubMedCrossRefGoogle Scholar
  23. 23.
    McGregor, C.G., Baldwin, J.G., Jamieson, S.W., Yousem, S.A., Burke, C.M., Oyer, P.E., Stinson, E.B. and Shumway, N.E. (1985). Isolated pulmonary rejection after combined heart—lung transplantation. J. Thorac. Cardiovasc. Surg., 90, 623PubMedGoogle Scholar
  24. 24.
    Theodore, J, Jamieson, S.W., Burke, C.M, Reitz, B.A, Stinson, E.B, van Kessel, A, Dawkins, K.D, Herran, J.J, Oyer, P.E, Hunt, S.A., Shumway, N.E. and Robin, E.D. (1984). Physiologic aspects of human heart—lung transplantation. Chest, 86, 349PubMedCrossRefGoogle Scholar
  25. 25.
    Heath, D. and Edwards, J.E. (1958). The pathology of hypertensive pulmonary vascular disease. A description of six grades of structural changes in the pulmonary arteries with special reference to congenital septal defects. Circulation, 18, 533PubMedGoogle Scholar
  26. 26.
    Billingham, M.E. (1979). Some recent advances in cardiac pathology. Hum. Pathol., 10, 367PubMedCrossRefGoogle Scholar
  27. 27.
    Griepp, R, Stinson, E, Bieber, C, Reitz, R.B, Copeland, J.G, Oyer, P.E. and Shumway, N.E. (1977). Control of graft arteriosclerosis in human heart transplant recipients. Surgery, 81, 262PubMedGoogle Scholar
  28. 28.
    Paradis, I.L, Marrari, M, Zeevi, A, Duquesnoy, R.J, Griffith, B.P, Hardesty, R.L. and Dauber, J.H. (1985). HLA phenotype of lung lavage cells following heart—lung transplantation. J. Heart Transplant., 4, 422PubMedGoogle Scholar
  29. 29.
    Zeevi, A, Fung, J.J, Paradis, I.L, Dauber, J.H, Griffith, B.P, Hardesty, R.L. and Duquesnoy, R.J. (1985). Lymphocytes of bronchoalveolar lavages from heart—lung transplant recipients. J. Heart Transplant., 4, 417PubMedGoogle Scholar
  30. 30.
    Gryzan, S, Paradis, I.L, Hardesty, R.L, Griffith, B.P. and Dauber, J.H. Bronchoalveolar lavage in heart—lung transplantation. J. Heart Transplant., 4, 414PubMedGoogle Scholar
  31. 31.
    Burke, C.M, Glanville, A.R, Theodore, J. and Robin, E.D. (1987). Lung immunogenicity, rejection and obliterative bronchiolitis. Chest, 92, 547PubMedCrossRefGoogle Scholar
  32. 32.
    Harjula, A, Baldwin, J.C, Glanville, A.R, Tazelaar, H, Oyer, P.E, Stinson, E.B, Shumway, N.E, (1987). Human leucocyte antigen compatibility in heart—lung transplantation. J. Heart Transplant., 6, 162PubMedGoogle Scholar
  33. 33.
    Romaniuk, A., Prop, J., Petersen, A.G., Wildevuur, C.R. and Nieuwenhuis, P. (1987). Expression of class II major histocompatibility complex antigens by bronchial epithelium in rat lung allografts. Transplantation, 44, 209PubMedCrossRefGoogle Scholar
  34. 34.
    Romaniuk, A., Prop, J., Petersen, A.H. et al (1987). Increased expression of class II MHC-antigens in rejecting and cyclosporine-treated rat lung allografts. Transplantation, 44, 209PubMedCrossRefGoogle Scholar
  35. 35.
    Dummer, J.S., Bahnson, H.T., Griffith, B.P., Hardesty, R.L., Thompson, M.E. and Ho, M. (1983). Infections in patients on cyclosporine and prednisone following cardiac transplantation. Transplant. Proc., 15, 2779Google Scholar
  36. 36.
    Wyatt, S, Nunn, J., Hows, J, Yin, J., Hayes, M.C, Cattovsky, G., Gordon-Smith, E.C., Hughes, J.M., Goldman, J.M. and Galton, D. (1984). Airways obstruction associated with graft-versus-host disease after bone marrow transplantation. Thorax, 29, 887CrossRefGoogle Scholar
  37. 37.
    Ralph, D., Springmeyer, S., Sullivan, K., Hackman, R.C., Storb, R. and Thomas, E.D. (1984). Rapid progressive airflow obstruction in marrow transplant recipients. Am. Rev. Respir. Dis., 129, 641PubMedGoogle Scholar
  38. 38.
    Beschorner, W., Saral, R., Hutchins, G., Tutschka, P.J. and Santos, G.W. (1978). Lymphocytic bronchitis associated with graft-versus-host disease in recipients of bone marrow transplants. N. Engl. J. Med., 299, 1030PubMedCrossRefGoogle Scholar
  39. 39.
    Stein-Streilein, J., Lipscomb, M., Hart, D. and Darden, A. (1981). Graft-versus-host reaction in the lung. Transplantation, 32, 38PubMedCrossRefGoogle Scholar
  40. 40.
    Grebe, S. and Streilein, J. (1976). Graft-versus-host reactions: a review. Adv. Immunol., 22, 119PubMedCrossRefGoogle Scholar
  41. 41.
    Urbanski, S.J., Kossakowska, A.E., Curtis, J., Chan, C.K., Hutcheon, M.A., Hyland, R.H., Messner, M. and Sculier, J.P. (1987). Idiopathic small airways pathology in patients with graft versus host disease following allogeneic bone marrow transplantation. Am. J. Surg. Pathol., 11, 965PubMedCrossRefGoogle Scholar
  42. 42.
    Geddes, D.H., Corrin, B., Brewerton, D.A., Davies, R.J. and Turner-Warwick, M. (1977). Progressive airway obliteration in adults and its association with rheumatoid disease. Quart. J. Med., 46, 427PubMedGoogle Scholar
  43. 43.
    Epier, G., Snider, G., Gaensler, E., Cathcart, E.S., Fitzgerald, M.X. and Carrington, C.B. (1979). Bronchiolitis and bronchitis in connective tissue disease. J. Am. Med. Assoc., 242, 528CrossRefGoogle Scholar
  44. 44.
    Murphy, K., Atkins, C., Offer, R., Hogg, J.C., and Stein, H.B., (1981). Obliterative bronchiolitis in two rheumatoid arthritis patients treated with penicillamine. Arth. Rheum., 24, 557CrossRefGoogle Scholar
  45. 45.
    Herzog, C., Miller, R. and Hoidal, J. (1981). Bronchiolitis and rheumatoid arthritis. Am. Rev. Respir. Dis., 124, 636PubMedGoogle Scholar
  46. 46.
    Marck, K.W., Prop, J.M., Wildevuur, C.R.H. and Nieuwenhuis, P. (1985). Lung transplantation in the rat: histopathology of left lung isolated allografts. J. Heart Transplant., 4, 263PubMedGoogle Scholar
  47. 47.
    Prop, J., Kuijpers, K., Peterson, A.H., Bartels, H.L., Nieuwenhuis, P. and Wildevuur, C.R. (1985). Why are lung allografts more vigorously rejected than hearts? J. Heart Transplant., 4, 433PubMedGoogle Scholar
  48. 48.
    Tazelaar, H.D., Prop, J., Nieuwenhuis, P., Billingham, M.E. and Wildevuur, C.R.H. (1986). Airway pathology in the transplanted rat lung. Am. J. Clin. Pathol., 86, 394 (abstract)Google Scholar
  49. 49.
    Prop, J., Tazelaar, H.D. and Billingham, M.E. (1987). Rejection of combined heart—lung transplants in rats: function and pathology. Am. J. Pathol., 127, 97PubMedGoogle Scholar
  50. 50.
    Allen, M.D., Burke, C.M., McGregor, C.G.A., Baldwin, J.C, Jamieson, S.W. and Theodore, J. (1986). Steroid responsive bronchiolitis after human heart—lung transplantation. J. Thorac. Cardiovasc. Surg., 92, 449PubMedGoogle Scholar
  51. 51.
    Gosink, B, Friedman, P. and Liebow, A. (1973). Bronchiolitis obliterans. Am. J. Roentgenol., 117, 816Google Scholar
  52. 52.
    Becroft, D. (1971). Bronchiolitis obliterans, bronchiectasis and other sequelae of adenovirus type 21 infection in younger children. J. Clin. Pathol., 24, 72PubMedCrossRefGoogle Scholar
  53. 53.
    Epler, G. and Colby, T. (1983). The spectrum of bronchiolitis obliterans. Chest, 83, 161PubMedCrossRefGoogle Scholar
  54. 54.
    Moran, T. and Hellstrom, H. (1958). Bronchiolitis obliterans. Arch. Pathol., 66, 691Google Scholar
  55. 55.
    Wohl, M. and Chernick, V. (1978). Bronchiolitis. Am. Rev. Respir. Dis., 118, 759PubMedGoogle Scholar
  56. 56.
    Brooks, R.G, Hofflin, J.M, Jamieson, S.W, Stinson, E.B. and Remington, J.S. (1985). Infectious complications in heart—lung transplant recipients. Am. J. Med., 79, 412PubMedCrossRefGoogle Scholar
  57. 57.
    Prop, J, Jansen, H.M, Wildevuur, C.R.H. and Nieuwenhuis, P. (1985). Lung allograft rejection in the rat. V. Inhaled stimuli aggravate the rejection response. Am. Rev. Respir. Dis., 132, 168PubMedGoogle Scholar
  58. 58.
    Higenbottam, T, Stewart, S, Penketh, A. and Wallwork, J. (1987). The diagnosis of lung rejection and opportunistic infection by transbronchial lung biopsy. Transplant. Proc., 19, 3777PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1990

Authors and Affiliations

  • S. A. Yousem

There are no affiliations available

Personalised recommendations