Hypoxic Gene Expression of Donor Bronchi Linked to Airway Complications after Lung Transplantation.
Journal Article (Journal Article)
RATIONALE: Central airway stenosis (CAS) after lung transplantation has been attributed in part to chronic airway ischemia; however, little is known about the time course or significance of large airway hypoxia early after transplantation. OBJECTIVES: To evaluate large airway oxygenation and hypoxic gene expression during the first month after lung transplantation and their relation to airway complications. METHODS: Subjects who underwent lung transplantation underwent endobronchial tissue oximetry of native and donor bronchi at 0, 3, and 30 days after transplantation (n = 11) and/or endobronchial biopsies (n = 14) at 30 days for real-time polymerase chain reaction of hypoxia-inducible genes. Patients were monitored for 6 months for the development of transplant-related complications. MEASUREMENTS AND MAIN RESULTS: Compared with native endobronchial tissues, donor tissue oxygen saturations (Sto2) were reduced in the upper lobes (74.1 ± 1.8% vs. 68.8 ± 1.7%; P < 0.05) and lower lobes (75.6 ± 1.6% vs. 71.5 ± 1.8%; P = 0.065) at 30 days post-transplantation. Donor upper lobe and subcarina Sto2 levels were also lower than the main carina (difference of -3.9 ± 1.5 and -4.8 ± 2.1, respectively; P < 0.05) at 30 days. Up-regulation of hypoxia-inducible genes VEGFA, FLT1, VEGFC, HMOX1, and TIE2 was significant in donor airways relative to native airways (all P < 0.05). VEGFA, KDR, and HMOX1 were associated with prolonged respiratory failure, prolonged hospitalization, extensive airway necrosis, and CAS (P < 0.05). CONCLUSIONS: These findings implicate donor bronchial hypoxia as a driving factor for post-transplantation airway complications. Strategies to improve airway oxygenation, such as bronchial artery re-anastomosis and hyperbaric oxygen therapy merit clinical investigation.
Full Text
Duke Authors
- Hartwig, Matthew
- Kraft, Bryan David
- Mahmood, Kamran
- Piantadosi, Claude Anthony
- Shofer, Scott Leigh
- Suliman, Hagir B.
Cited Authors
- Kraft, BD; Suliman, HB; Colman, EC; Mahmood, K; Hartwig, MG; Piantadosi, CA; Shofer, SL
Published Date
- March 1, 2016
Published In
Volume / Issue
- 193 / 5
Start / End Page
- 552 - 560
PubMed ID
- 26488115
Pubmed Central ID
- PMC5440847
Electronic International Standard Serial Number (EISSN)
- 1535-4970
Digital Object Identifier (DOI)
- 10.1164/rccm.201508-1634OC
Language
- eng
Conference Location
- United States