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2016 ; 21
(3
): 279-84
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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
PMID26967995
show 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 preclinical 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. Preclinical studies indicate the
importance of hypoxia-inducible factor-1? in mediating microvascular repair and
that hypoxia-inducible factor-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. Although 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.
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