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Lung Transplantation and the Blood–Gas Barrier

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The Vertebrate Blood-Gas Barrier in Health and Disease

Abstract

The blood–gas barrier (BGB) is subjected to a variety of stressors during all the phases of lung transplantation. These result in ischemia-reperfusion (IR) injury and can manifest clinically as primary graft dysfunction (PGD). IR injury affects the epithelium, interstitium, and endothelium of the alveolar septa as well as the pulmonary surfactant system. It leads to functional and morphological damage and death of pulmonary cells, largely due to an inflammatory response by activated resident cells as well as inflammatory cell infiltration, which is governed by a large number of mediators. Since PGD is the major cause of early morbidity and mortality after lung transplantation, much effort is undertaken from organ procurement to preservation and implantation to prevent or ameliorate IR injury, including surgical management procedures and pharmacological additives to perfusion solutions or ventilation gas. In particular, to increase the rate of transplantable donor organs, very promising results are achieved by the new technique of ex vivo lung perfusion (EVLP). Beyond the immediate transplantation period, the BGB is jeopardized in certain forms of acute rejection and chronic lung allograft dysfunction.

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Abbreviations

ALI:

Acute lung injury

AMR:

Acute antibody-mediated rejection

ARDS:

Acute respiratory distress syndrome

BAL:

Bronchoalveolar lavage

BGB:

Blood-gas barrier

BOS:

Bronchiolitis obliterans syndrome

C4d:

Complement 4d

CICD:

Caspase-independent cell death

CLAD:

Chronic lung allograft dysfunction

DBD:

Donated after brain death

DCD:

Donated after cardiac death

DSA:

Donor-specific antibodies

ECMO:

Extracorporal membrane oxygenation

EVLP:

Ex vivo lung perfusion

FEV1 :

Forced expiratory volume in 1 s

IR:

Ischemia-reperfusion

ISHLT:

International Society for Heart and Lung Transplantation

LPD:

Low-potassium dextran

NHBD:

Non-heart-beating donors

NK:

Natural killer cells

NO:

Nitric oxide

OB:

Obliterative bronchiolitis

PEEP:

Positive end-expiratory pressure

PGD:

Primary graft dysfunction

PVR:

Pulmonary vascular resistance

RAS:

Restrictive allograft syndrome

ROS:

Reactive oxygen species

SA/LA ratio:

Small aggregate to large aggregate ratio

SP:

Surfactant protein

TLC:

Total lung capacity

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  1. Institute of Functional and Applied Anatomy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Anke Schnapper DVM & Matthias Ochs MD

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  1. Department of Veterinary Anatomy and Physiology, University of Nairobi, Nairobi, Kenya

    Andrew N. Makanya

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Schnapper, A., Ochs, M. (2015). Lung Transplantation and the Blood–Gas Barrier. In: Makanya, A. (eds) The Vertebrate Blood-Gas Barrier in Health and Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-18392-3_9

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