LUNG TRANSPLANTATION IN DOGS 
James D. Hardy* 
The incidence of chronic pulmonary insufficiency is 
steadily increasing in the United States. Chronic ob- 
structive emphysema is the most prominent cause of 
lung disability, but tuberculosis, pneumoconioses, bron- 
chiectasis, and chronic cystic fibrosis contribute addi- 
tional cases. The work loss caused by chronic respiratory 
failure is substantial, and a large number of patients 
with such limitations eventually die from lung or sec- 
ondary heart disease. Therefore, it is imperative to 
investigate means for relieving otherwise terminal 
chronic respiratory insufficiency, and the investigation 
of lung transplantation in animals has appeared to rep- 
resent a feasible approach to the solution of this prob- 
lem. While experiments have been performed in lower 
primates and the pig, and perhaps other animals, the 
dog has been most commonly utilized because of its 
ready availability in large numbers and the ease with 
which this animal can be handled. This report will deal 
principally with canine lung transplant research per- 
formed in our own laboratories, but related work by 
others will be briefly acknowledged. 
INTRODUCTION 
The first lung transplant recorded would ap- 
pear to have been that of Guthrie in 1907, 
which involved the transfer of the lungs of a 
kitten to the neck vessels of an adult.^ The lungs 
became edematous, and the experiment was 
terminated at 48 hours because of infection. 
Transplantation of the whole lung and pulmo- 
nary lobes in dogs was performed by Demikhov 
of the Soviet Union in 1947, but this report did 
not become available to the Western world until 
I 1962.2 Staudacher and associates ^ published 
results of replantation and allotransplantation 
of pulmonary lobes in dogs in 1950. In that same 
year Metras* reported the technique of lung 
transplantation which placed the anastomosis 
through a portion of the left atrium into which 
the involved pulmonary veins flowed, thus 
avoiding the high incidence thrombosis incurred 
j when the pulmonary veins of dogs were ana- 
• University of Mississippi Medical Center, Department of Surgery, 
Jackson, Mississippi. 
stomosed individually. This rapidly became the 
standard technique for present day experi- 
ments in animals. Neptune and associates^ in- 
dependently described a similar type of anasto- 
mosis one year later. Lung replantation was 
given strong emphasis when Juvenelle and his 
co-workers^ reported the long-term survival 
of a dog whose right lung was replanted in 
1950. 
LUNG REPLANTATION 
Lung replantation has been studied exten- 
sively in the dog, since the study of this model 
avoids the immunological problems which are 
produced with an allograft.'^-^^ Thus, the phys- 
iological and other changes which occur are 
due to the cumulative effects of the operation of 
removing the lung and then replacing it in the 
original position, and no immunological reac- 
tion that would have been caused by transplant- 
ing genetically dissimilar tissue need by con- 
sidered. 
Replantation of One Lung 
Operative Technique 
In lung replantation the organ is removed, 
cooled and washed by perfusion at physiologic 
pressure through its pulmonary artery (Rhe- 
omacrodex or Ringer's lactate at +4°C), and 
then the organ is sutured back in its original 
position. Some workers prefer to inject heparin 
into the vascular tree while the organ is without 
perfusion with blood, to reduce the risk of small 
vessel thrombosis during the period of stasis. 
However, we have not used it routinely and we 
do not find it essential to do so. Furthermore, 
most of the blood has usually been removed from 
the lung by perfusion, but even this is not man- 
datory if the lung is promptly reinserted. 
In the dog we have found the use of a left 
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