mouse-heterotopic-cervical-cardiac-transplantation-utilizing-vascular

Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs

Murine models of cardiac transplantation are frequently utilized to study ischemia-reperfusion injury, innate and adaptive immune responses after ...

Washington University School of Medicine

Bronchial arteriovenous malformations are usually asymptomatic findings noted on imaging but may present with massive hemoptysis after endobronchial rupture. Initial treatment usually involves transcatheter embolization with surgery reserved for refractory cases. Here, we present a patient with large-volume hemoptysis after bronchial arteriovenous malformation rupture. Attempted endovascular management was unsuccessful owing to unfavorable anatomy and hemodynamic instability, necessitating emergent use of extracorporeal membrane oxygenation followed by right bilobectomy.

Emergent Lung Resection for Massive Hemoptysis From Bronchial Malformation.

Immune responses following lung transplantation continue to result in high rates of allograft failure and rejection, and current immunosuppression does not address the unique immunologic properties of the lung. Here, we review recent studies on lung allograft tolerance and alloimmunity and discuss implications for immunosuppression.

Tolerance, immunosuppression, and immune modulation: impacts on lung allograft survival.

Innate immune pathways early after pulmonary transplantation have been shown to cause primary graft dysfunction (PGD) and also predispose to late graft failure. Recent studies in animal models have elucidated critical mechanisms governing such innate immune responses. Here, we discuss pathways of inflammatory cell death, triggers for sterile and infectious inflammation, and signaling cascades that mediate lung injury early after transplantation. These studies highlight potential avenues for lung-specific therapies early following lung transplantation to dampen innate immune responses and improve outcomes.

Innate immunity in lung transplantation.

The rising need for lung transplantation over recent years has not paralleled the availability of suitable lung allografts. The number of lung transplantations performed each year in the United States remains limited by an inadequate supply of suitable donors as well as low donor utilization rates. While several methods have been proposed for increasing the donor pool, there is considerable disparity between acceptance and utilization of these practices among transplant centers. In this review article, we explore various approaches for enhancing donor selection and expanding the donor pool. We discuss the use of "extended criteria" donors including high risk groups such as drug overdose donors, and we examine the role of techniques in donor assessment and selection such as the use of computed tomography for accurate size matching. We review topics in donor management such as the establishment of specialized donor care facilities and the implementation of lung-focused resuscitation protocols, and we discuss advancements in donor procurement such as the utilization of local procurement teams. We also review barriers to donation, such as variability in organ procurement organization (OPO) consent practices, as well as patient-specific factors such as religious or cultural beliefs. Addressing these aspects of donor evaluation, management, and accessibility is essential in maximizing the number of lungs available for transplantation within the existing donor pool.

Advanced considerations in organ donors.

Partial anomalous pulmonary venous return is a rare congenital aberrancy which involves oxygen-rich pulmonary venous drainage into the right atrium instead of systemic circulation. Here, we report a case of isolated partial anomalous pulmonary venous return of the right upper lobe in a donor lung. Successful transplantation was performed with a Carrel patch technique for left atrial cuff reconstruction using a segment of donor vena cava. This is the third report of partial anomalous pulmonary venous return in a right donor lung, but the first to describe this reconstructive approach to restore physiologic venous drainage.

Transplantation of Donor Lung with Partial Anomalous Pulmonary Venous Return Using a Carrel Patch.

Tertiary lymphoid organs (TLOs) are collections of immune cells resembling secondary lymphoid organs (SLOs) that form in peripheral, non-lymphoid tissues in response to local chronic inflammation. While their formation mimics embryologic lymphoid organogenesis, TLOs form after birth at ectopic sites in response to local inflammation resulting in their ability to mount diverse immune responses. The structure of TLOs can vary from clusters of B and T lymphocytes to highly organized structures with B and T lymphocyte compartments, germinal centers, and lymphatic vessels (LVs) and high endothelial venules (HEVs), allowing them to generate robust immune responses at sites of tissue injury. Although our understanding of the formation and function of these structures has improved greatly over the last 30 years, their role as mediators of protective or pathologic immune responses in certain chronic inflammatory diseases remains enigmatic and may differ based on the local tissue microenvironment in which they form. In this review, we highlight the role of TLOs in the regulation of immune responses in chronic infection, chronic inflammatory and autoimmune diseases, cancer, and solid organ transplantation.

Article	Year
Emergent Lung Resection for Massive Hemoptysis From Bronchial Malformation. The Annals of thoracic surgery\| PubMed ID: 33676901	2021
Tolerance, immunosuppression, and immune modulation: impacts on lung allograft survival. Current opinion in organ transplantation\| PubMed ID: 33782247	2021
Innate immunity in lung transplantation. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation\| PubMed ID: 34020867	2021
Advanced considerations in organ donors. Journal of thoracic disease\| PubMed ID: 34992832	2021
Transplantation of Donor Lung with Partial Anomalous Pulmonary Venous Return Using a Carrel Patch. The Annals of thoracic surgery\| PubMed ID: 34998737	2022
Role of tertiary lymphoid organs in the regulation of immune responses in the periphery. Cellular and molecular life sciences : CMLS\| PubMed ID: 35689679	2022

Hailey M. Shepherd

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