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In the last years, lung transplantation has become a widely accepted treatment for the patients suffering from end-stage chronic lung disease. This study was aimed at investigating the role of diagnostic imaging techniques before and after lung transplantation, in the light of the physiopathological changes occurring in transplanted lungs. Our study included 4 patients (3 men and 1 woman, age range: 33-58 years): 3 of them underwent single lung transplantation and one double lung transplantation. All the operations were successful. Chest radiographs and HRCT showed the main early and late complications that occurred after transplantation. In the early postoperative period, the reperfusion syndrome was observed in 2 patients and acute rejection in the 3 patients submitted to single lung transplantation. In the late postoperative period, chronic rejection occurred in the patient submitted to left lung transplantation. None of our patients presented any infection or such airway complications as bronchial dehiscence or strictures. Both literature data and our personal experience show that preoperative diagnostic imaging allows the assessment of lung conditions, which helps choose the better side for transplantation. Moreover, lung size must be studied to match the donor's lung to the recipient's chest. In the postoperative period, both early and late complications must be investigated, all of them characterized by aspecific radiologic findings. Currently, time plays a major diagnostic role but we hope that more accurate interpretation of radiologic findings will improve the clinical assessment of lung transplant recipients.

During the period March 1991-June 1992 5 single lung transplantations were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent regular fibrobronchoscopies within the context of a complex follow-up programme in order to monitor the resolution of the bronchial anastomosis and identify the onset of intercurrent lung infections and rejections using bronchioalveolar lavage (BAL) and transbronchial biopsies (TBB). Forty-four fibrobronchoscopies were performed of which 24 for anastomotic follow-up, BAL and TBB, and 20 for the simple monitoring of the anastomosis. Fibrobronchoscopies confirmed the optimal resolution of bronchial anastomosis in 4 patients, whereas one patient showed a granulomatous anastomotic reaction which was successfully treated using local steroid injections. Although recovery was normal in one patient, kinking appeared in the bronchus of the receiving lung which was successfully treated by the insertion of Gianturco prosthesis. BAL enabled the identification of 2 CMV infections, one Pseudomonas aeruginosa, one Haemophilus influenzae and one Pneumocystis carinii infection. TBB allowed 3 cases of CMW lung infection and 7 episodes of rejection to be diagnosed. The authors' personal experience confirms the decisive role played by bronchoscopy in the follow-up of lung transplant patients. This procedure allowed bronchial anastomosis to be closely monitored and was of vital importance in the diagnosis of lung infections and rejection.

Experimental surgery in animals remains an irreplaceable model for the clinical application of a new technique. We performed a single lung allotransplantation in young pigs. The pigs were organized into groups: 1) 6 to assess the surgical anatomy; 2) 10 to receive left transplantation; 3) 3 to study the pathophysiology of the transplanted lung. The preliminary results demonstrated that the surgical model is useful.

Single lung transplantation was performed in 22 pigs. The first 10 experiments were devoted to settle the surgical technique: in these cases we employed small animals (8-12 kg); technical difficulties and the high incidence of perioperative complications induced us to utilize bigger animals (greater than 20 kg) in the subsequent experiments. In the recipient, after left pneumonectomy we prepared the right pulmonary artery and encircled it with an inflatable silicon cuff connected to a reservoir positioned outside the chest cavity of the animal. The inflation of the cuff allows the complete occlusion of the right pulmonary artery and thus the functional evaluation of the isolated transplanted lung. Perioperative functional evaluation has been performed at different times till the third postoperative day, documenting the good status of the transplanted lung. This study confirms the possibility to employ pigs for experimental single lung transplantation to settle the surgical technique with economic and organizing advantages. Furthermore, it confirms the good results achieved in the dog, in which the occlusion of the contralateral pulmonary artery by means of an inflatable silicon cuff allows to evaluate the isolated transplanted lung function.