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Microvascular injury after lung transplantation #MMPMID26967995
Nicolls MR; Hsu JL; Jiang X
Curr Opin Organ Transplant 2016[Jun]; 21 (3): 279-84 PMID26967995show ga
Purpose of review: Airway microvessel injury following transplantation has been implicated in the development of chronic rejection. This review focuses on the most recent developments in the field describing pre-clinical and clinical findings that further implicate the loss of microvascular integrity as an important pathological event in the evolution of irreversible fibrotic remodeling. Recent findings: When lungs are transplanted, the airways appear vulnerable from the perspective of perfusion. Two vascular systems are lost, the bronchial artery and the lymphatic circulations, and the remaining vasculature in the airways expresses donor antigens susceptible to alloimmune-mediated injury via innate and adaptive immune mechanisms. Pre-clinical studies indicate the importance of HIF-1? in mediating microvascular repair and that HIF-1 ? can be upregulated to bolster endogenous repair. Summary: Airway microvascular injury is a feature of lung transplantation that limits short-term and long-term organ health. While some problems are attributable to a missing bronchial artery circulation, another significant issue involves alloimmune-mediated injury to transplant airway microvessels. For a variety of reasons, bronchial artery revascularization surgery at the time of transplantation has not been widely adopted, and the current best hope for this era may be new medical approaches that offer protection against immune-mediated vascular injury or that promote microvascular repair.