Background
Since the advent of ex vivo lung perfusion (EVLP), there has been increased focus on swine models of lung transplantation;
however, the anatomic differences between human and swine lungs and the technical
challenges in performing porcine lung transplantation are not well described in the
surgical literature.
Methods
Surgically important anatomic variations are described, and the technical measures
taken to address them during harvest and transplantation are introduced.
Results
There are three surgically important anatomic variations in pigs. First, the right
cranial lobe bronchus arises directly from the trachea, which makes right lung transplantation
technically challenging if not prohibitive. Second, the left hemi-azygos vein is fully
developed and courses upward through the posterior mediastinum, where it crosses the
left pulmonary hilum and drains directly into the coronary sinus. During transplantation,
this vein is ligated and dissected away to expose the underlying left pulmonary hilar
structures. Third, the right inferior pulmonary vein crosses the midline to drain
into the left atrium immediately adjacent to the left inferior pulmonary vein. During
donor lung preparation, the right inferior pulmonary vein is ligated distally from
the left atrium, which leaves an adequate atrial cuff around the left sided pulmonary
veins for later anastomosis.
Conclusion
Experimental porcine lung transplantation is technically demanding. We have found
recognition of the above described anatomical differences and technical nuances facilitate
transplantation and provide reproducible results.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Technique for prolonged normothermic ex vivo lung perfusion.J Heart Lung Transplant. 2008; 27: 1319
- Transplantation of lungs from non-heart-beating donors after functional assessment ex vivo.Ann Thorac Surg. 2003; 76: 244
- Functional repair of human donor lungs by IL-10 gene therapy.Sci Transl Med. 2009; 1: 4ra9
- Relevant radiological anatomy of the pig as a training model in interventional radiology.Eur Radiol. 1998; 8: 1254
- Bronchial tree, lobular division and blood vessels of the pig lung.J Vet Med Sci. 1994; 56: 685
- Swine in the Laboratory.2nd ed. Taylor and Francis Group, Boca Raton, FL2007 (213–214)
- Effects of short-term inhaled nitric oxide on interleukin-8 release after single-lung transplantation in pigs.J Heart Lung Transplant. 2005; 24: 714
- Adenosine A2A receptor activation reduces inflammation and preserves pulmonary function in an in vivo model of lung transplantation.J Thorac Cardiovasc Surg. 2005; 129: 1137
- Sildenafil extends survival and graft function in a large animal lung transplantation model.Eur J Cardiothorac Surg. 2006; 29: 288
- PDE-5 inhibitor donor intravenous preconditioning is superior to supplementation in standard preservation solution in experimental lung transplantation.Eur J Cardiothorac Surg. 2007; 32: 42
- Disseminated intravascular coagulation in association with pig-to-primate pulmonary xenotransplantation.Transplantation. 2002; 73: 1717
- Total respiratory support from swine lungs in primate recipients.J Thorac Cardiovasc Surg. 1998; 115: 19
Article info
Publication history
Published online: June 27, 2011
Received:
April 21,
2011
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
