Deneysel Akciğer Nakli Modelinde Cerrahi Teknik ve Perioperatif Ventilasyon Stratejilerinin Geliştirilmesi

Abstract

Lung transplantation remains the definitive treatment for end-stage pulmonary diseases, yet its clinical application continues to be hindered by complex surgical demands, immunological challenges, and suboptimal long-term outcomes. Animal models, particularly rat orthotopic lung transplantation, serve as essential tools for elucidating rejection mechanisms and evaluating novel therapeutic strategies. However, the steep learning curve and high technical demands have limited widespread adoption and reproducibility in preclinical studies. This study introduces a refined rat lung transplantation model incorporating several novel modifications designed to enhance procedural reliability and support long-term graft viability. A total of 40 left lung transplantations were performed, divided into two groups: Conventional Technique (CT) and Improved Technique (IT). Technical refinements included optimized cuff design, atraumatic graft handling on a pressure-absorbing platform, a sequential artery–bronchus–vein anastomosis order, and transient reclamping of the pulmonary artery for controlled reperfusion. Additionally, a tailored mechanical ventilation strategy was applied to minimize graft injury and optimize gas exchange. The IT group exhibited a significantly higher surgical success rate (96.3% vs. 53.8%), improved one-hour postoperative oxygenation, and consistent seven-day survival. Furthermore, long-term survivors (2–6 months) demonstrated preserved graft architecture and a gradual shift from acute rejection to chronic fibrotic remodeling on histopathological analysis. These findings suggest that the introduced protocol provides a reproducible, cost-effective, and technically accessible experimental platform for translational lung transplantation research. The model eliminates the need for high-cost infrastructure, offering a valuable tool for studying chronic rejection and evaluating emerging immunomodulatory approaches in a controlled and clinically relevant setting.