CoーOperative Study for Clinical Application of Lung and Heart-Lung Transplantation

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In the near future lung or heart-lung transplantation will be performed in Japan.At that time we should certainly prevent failures due to rejection. We have performed basic studies such as an organ preservation, monitoring of early rejection, observation of wound healing of anastomotic site of the bronchi, immunosuppressive treatment etc.Organ can be preserved for 5-6 hours using Euro-Collins solution, but the possibility of prolongation for 12-24 hours by the addition of CA^<++>antagonist and/or antioxydizing agents (SOD, CoQ10). In the case of heart-lung preservation, reperfusion injury sometimes develops.In order to suppress this, the application of compliment-activated agent (FUT-175) and/or perfusion using blood from which leukocytes have been removed seem effective. At present as we cannot obtain donor lung from brain death case, use of lungs after cardiac arrest is considered. According to injection of heparin and predonisolone before cardiac arrest in animals preservation for 24 hours will be possible using lung extracted 2 hours after cardiac arrest. For physiological and immunological study of lung and heart-lung transplantation are being performed in rats. Shortening of operation time and ischemic time and improvement of survival rate were obtained. As monitoring parameters of early rejection there was a relationship between early rejection and total cell number, cell analysis, CD4/CD8 rate of leukocytes in BALF in rat, canine and monkey lung transplantation models.In relation to this, donor-specific cytotoxic activity derived from T lymphocytes was observed. There was similar effects of new immunosuppressive agents (FK506 and DSG) compared to cyclosporin A, To observe wound healing of the anastomotic site of the bronchi endoscopic observation of the lesion using fluorescence and blood flow measurement by laser Doppler Velocity were used. A mannual of lung and heart-lung transplantation was published as a step towards human application.