Pathological findings after right lung transplantation in a patient with fibrosing alveolitis

The pathological findings in a patient who died two months after right lung transplantation for fibrosing alveolitis are reported. The cause of death was haemoptysis, due to penetrating ulceration causing a fistula between the surface of the cartilagenous part of the main bronchus of the donor lung and the right upper lobe pulmonary artery. The opening in the donor bronchus was immediately distal to the line of the bronchial anastomosis and through an actively inflamed area. Other parts of the donor bronchus had microscopic changes suggesting ischaemia, emphasizing that inadequacy of blood supply to the donor extrapulmonary bronchus is one of the most serious hazards of lung transplantation. Within the lung, histological features of rejection were mild and there was minimal evidence of infection. Another question raised by this case is whether the donor lung was in the process of developing the original disease, evidence for which was sought electron microscopically but was not proven.