Heart and lung transplantation: autotransplantation and allotransplantation in primates with extended survival.

TLDR

Combined heart and lung transplantation was performed in rhesus or cynomolgus monkeys to confirm primates can withstand complete cardiopulmonary denervation, develop a satisfactory operative method, and achieve allotransplant survival with Cyclosporin‑A immune suppression. The authors sought to confirm primates’ tolerance of complete cardiopulmonary denervation, refine operative techniques, and evaluate allotransplant survival under Cyclosporin‑A immunosuppression. Twenty‑seven rhesus or cynomolgus monkeys underwent autotransplant or allotransplant procedures using two operative techniques, including hypothermia with circulatory arrest for 17 animals. One autotransplant survived 368 days, untreated allotransplants died within 5 days, but with cardiopulmonary bypass outcomes improved; three autotransplants survived 60–312 days, and three of seven allotransplants treated with Cyclosporin‑A and azathioprine survived long‑term (up to 191 days), demonstrating that heart‑lung transplantation is feasible in primates and allografts can endure extended periods under Cyclosporin‑A immunosuppression.

Abstract

Combined heart and lung transplantation was performed in rhesus or cynomolgus monkeys in order to confirm the ability of primates to withstand complete cardiopulmonary denervation, to develop a satisfactory operative method, and to obtain survival of allotransplant recipients using Cyclosporin-A immune suppression. Twenty-seven monkeys weighing 2.6 to 10.1 kg received either autotransplants or allotransplants by two different operative techniques. Seventeen animals were operated upon with hypothermia and circulatory arrest. One autotransplant recipient is alive at 368 days, but all allotransplant recipients (untreated) died within 5 days despite normal breathing patterns. Ten animals operated upon with the aid of cardiopulmonary bypass fared better. Three autotransplant recipients are alive 60, 199, and 312 days postoperatively. Three of seven allotransplant recipients treated with Cyclosporin-A (25 mg/kg, then tapered) and azathioprine (2 mg/kg for 14 days) were long-term survivors. One died at 144 days of lymphoma and two are currently living 156 and 191 days postoperatively. The results suggest that heart and lung transplantation is possible in primates and that allografted recipients can survive for extended periods with Cyclosporin-A used for immune suppression.