IMPROVEMENT OF TRACHEAL AUTOGRAFT REVASCULARIZATION BY MEANS OF FIBROBLAST GROWTH-FACTOR

Ischemic airway complications after lung transplantation remain a sign ificant problem despite the use of bronchial omentopexy. Clinical obse rvations suggest that enhancement of vascular ingrowth could possibly increase the efficacy of a bronchial omental flap. This study was ther efore designed to investigate whether basic fibroblast growth factor c an enhance blood supply of an ischemic airway by acceleration of vascu lar ingrowth in a rabbit autotransplant model. Segments of the trachea were harvested and transplanted into a subcutaneous pouch. The animal s were randomly assigned to one of four groups: group I, no omentopexy ; group II, omentopexy; group III, omentopexy and fibrin glue; or grou p IV, omentopexy and fibrin glue enriched with 2.5 mu g basic fibrobla st growth factor. After 14 days the animals were sacrificed. The exten t of perfusion was investigated by means of radioactive microspheres. The morphology of the tracheal segments was investigated in a blinded fashion macroscopically, by means of light microscopy, and by means of scanning electron microscopy. The radioactivity measurements revealed a significantly increased perfusion of group IV (77% +/- 42%) as comp ared with groups I (17% +/- 13%) and III (20% +/- 16%). By macroscopic and light microscopic assessment, the epithelial integrity of group I V was significantly improved compared with groups I and II. At electro n microscopy the integrity of group IV was significantly superior to a ll remaining groups. We conclude that a deposit of basic fibroblast gr owth factor and fibrin glue appears to increase revascularization of a n ischemic airway from omentum and thus results in improved epithelial preservation of a tracheal autograft.