Chronic allograft dysfunction (CLAD) remains a major complication, causing the poor survival after lung transplantation (Tx). Although strenuous efforts have been made at preventing CLAD, surgical approaches for lung Tx have not been updated over the last 2 decades. The bronchial artery (BA), which supplies oxygenated blood to the airways and constitutes a functional microvasculature, has occasionally been revascularized during transplants, but this technique did not gain popularity and is not standard in current lung Tx protocols, despite the fact that a small number of studies have shown beneficial effects of BA revascularization on limiting CLAD. Also, recent basic and clinical evidence has demonstrated the relationship between microvasculature damage and CLAD. Thus, the protection of the bronchial circulation and microvasculature in lung grafts may be a key factor to overcome CLAD. This review revisits the history of BA revascularization, discusses the role of the bronchial circulation in lung Tx, and advocates for novel bronchial-arterial-circulation sparing approaches as a future direction for overcoming CLAD. Although there are some already published review articles summarizing the surgical techniques and their possible contribution to outcomes in lung Tx, to the best of our knowledge, this review is the first to elaborate on bronchial circulation that will contribute to prevent CLAD from both scientific and clinical perspectives: from bedside to bench to bedside, and beyond.
This review revisits the history of bronchial artery revascularization, discusses the role of the bronchial circulation in lung transplantation, and advocates for novel bronchial-arterial-circulation-sparing approaches as a future direction for overcoming chronic lung allograft dysfunction.
1 Division of Cardiovascular Surgery, Temple University Health System and Lewis Katz School of Medicine, Philadelphia, PA.
2 Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Received 18 December 2017. Revision received 6 March 2018.
Accepted 8 March 2018.
The authors declare no funding or conflicts of interest.
N.S. and S.T. participated in review design. N.S., S.T., and K.N. participated in data collection. N.S. and S.T. participated in the writing of the article.
Correspondence: Norihisa Shigemura, MD, PhD, Temple University Hospital, 3401N, Broad St, Parkinson Pavilion, Suite 301, Zone C, Philadelphia, PA 19140. (Norihisa.Shigemura@tuhs.temple.edu).