Autotransplantation of the lung in sheep.

Since the pioneer work of Demikhov (1962), Staudacher, Bellinazzo, and Pulin (1950), and Juvenelle, Citret, Wiles, and Stewart (1951), the possibilities and problems of lung transplantation have received increasing attention, and indeed homotransplantation has already been attempted in man (Hardy, Webb, Dalton, and Walker, 1963b; Magovern and Yates, 1964). Before transplantation of a lung becomes a generally acceptable method of treating patients with respiratory disease, there are three problems or groups of problems which must be overcome. First, the technical problems of inserting or implanting a lung must be understood and mastered. Secondly, there is the immunological barrier, and thirdly the supply and preservation of suitable lungs. This paper is concerned solely with the first problem, the technical difficulties of implantation and their relation to the subsequent function of the implanted lung. Autotransplantation, where the lung is removed and then reimplanted, is the ideal way to examine this problem, since it avoids the immunological reaction. Other workers (Blumenstock and Kahn, 1961; Hardy, Eraslan, and Dalton, 1963a; Reemtsma, Rogers, Lucas, Schmidt, and Davis, 1963) have reported their experience with autotransplantation of a lung in the dog, and the techniques of operation are already well docume?ited. Autograft function may return to normal, -but it is more usual for there to be some reduction, and this is often considerable. The reasons do not seem to be understood and we thought the problem demanded particular study. Certainly the reported variation in autograft function suggested an avoidable cause, and we were reluctant to believe that the procedure itself necessarily led to impaired pulmonary function.