The Expression Of Intercellular Adhesion Molecule-1(ICAM-1) On Rat Lung Allograft When Pulmnary Allograft Rejection Develops.

Objective1. To establish rat orthotopic left pulmonary allograft transplantation by improvingthe "cuff-like"vessel anastomosis technique, which will provide a basic model forfuther research of lung preservation, ischemical reperfusion injury, immunologicalrejection.2. To investigate the expression of intercellular adhesion molecule-1(ICAM-1) onrat lung allografts when pulmnary allograft rejection develops, and the effect ofcyclosporinA on it, so to analysis the possibility of clinical use of intercellularadhesion molecule-1(ICAM-1) in diagnosis of pulmnary allograft rejection .MethodsThis study is divided into two parts:1. Part one: We established rat orthotopic left pulmonary allograft transplantation ,in which the anastomosis of pulmonary artery, vein and bronchus was performed byusing the improved cuff technique . When the transplanted lung had been reperfusedfor 4h, the right hilus of lung was clipped. Just before and 20 min after clipping,systemic PaO2 and PaCO2 were determined in blood samples from abdominal aorta.And pathologic study were conducted 5d after operation.2. 8 normal rats were obtained and 24 transplantations were performed, the caseswere divided into 4 groups: Goup A(n=8) is normal control group, group B(n=8):male SD rats underwent left lung transplantation with isografts from SD rats, groupC(n=8): male SD rats underwent left lung transplantation with allografts from Wistarrats, group D(n=8): male SD rats underwent left lung transplantation with allograftsfrom Wistar rats, and CsA was used 1-5 days after transplantation. In all groupsrecipients were killed on postoperative day 5. The expression of intercellular adhesionmolecule-1(ICAM-1) was assessed by means of immunohistochemistry. Andpathological morphologic change was analyzed. Results1. In 30 consecutive cases, 26 have been performed successfully by single surgeon.The operation successful rate was 86.7%, and the survival rate was 100% on thepostoperative day 14.The total time of surgical procedure was(60±3)min, and theaverage graft ischemia time was (25±5)min. On 4h and 5 day after operation,pathologic study found the typical pathologic change of ischemia-reperfution inducedlung injury and acute pulmonary allograft rejection.2. Pathologic change of pulmonary allograft: In homologous series group, the lungtissue was nearly normal, only rare infiltration of lymphocytes were found. Inallogene group, there are a lot of lymphocytes, monocytes infiltration surrounding theblood vessel and bronchus like sleeves. Endoaniitis and lung tissue necrosis can alsobe found. In allogene with medication group, the injury of grafts were relievedsignificantly.3. The expression of ICAM-1 in pulmonary allograft: In normal lung tissue it was notexpressed.; In allogene group, its content increased significantly, comparing withisograft group or allogene with medication group.(p<0.05). Conclusion1. By using the improved "cuff-like"vessel anastomosis, rat orthotopic left lungtransplantation model was successfully estabished. It is a simple, economical,practicable, and high reproducible model, and can be applied to study donor lungpreservation, lung ischemia-reperfution injury and pulmonary allograft rejection.2. Pathologic change of pulmonary allograft include: lymphocytes, monocytesinfiltration, Endoaniitis and lung tissue necrosis, which indicates that acute rejectiondevelops.3. Intercellular adhesion molecule-1(ICAM-1) excessively express in allograftsduring acute rejection after rat lung trasplantation which can be suppressed bycyclosporin A. So we deduce that intercellular adhesion molecule-1(ICAM-1) maybe used in clinical diagnosis of pulmnary allograft rejection .