Experience with Nerve Allograft Transplantation

Abstract

Nerve allograft transplantation should be used for the repair of devastating peripheral nerve injuries that cannot be reconstructed through traditional means such as autologous nerve grafting or nerve transfer procedures. The risks of required systemic immunosuppression, although only temporary for nerve allograft recipients, preclude widespread use of this treatment modality. Translational research has led to several advancements in this field including the use of preoperative allograft cold preservation in University of Wisconsin organ preservation solution and inclusion of tacrolimus as part of the immunosuppressive regimen. Investigation of how to further diminish nerve allograft immunogenicity, speed neuroregeneration by use of agents such as tacrolimus, and promote preferential motor regeneration will further advance this field with the goal of restoring optimal function while minimizing patient morbidity.

Adult Peripheral Nerve Disorders: Nerve Entrapment, Repair, Transfer, and Brachial Plexus Disorders

“…(26) Therefore conduit use is only clearly indicated for sensory function such as repair of the non-critical sensory zones of the hand; we recommend use of autologous nerve graft for the first web space critical sensory area. Nerve allotransplantation carries risks of immunosuppression, however temporary, and should be reserved for special cases where no other options exist(27). …”

Serial assessment of functional recovery following nerve injury using implantable thin‐film wireless nerve stimulators

“…Comprehensive understanding of the time course of nerve injury, degeneration of distal axons, and functional status of terminal end organs predicts the maximal degree of functional recovery expected following surgical repair . Further examination of the time course of nerve regeneration using various nerve grafting and repair methods may provide critical insight into the expected time course and terminal capacity for functional recovery . A combination of both perspectives may provide a unique system for evaluating and selecting nerve repair strategies that optimally harness remaining regenerative potential or fit with the regenerative time frame available in each case.…”

Clinical Strategies to Enhance Nerve Regeneration in Composite Tissue Allotransplantation

“…Therefore, as long as there is no individual contraindication to therapy, FK-506 should be provided as part of immunosuppression induction, as it was for all hand transplant patients between 1998 and 2006[20]. Ideally, the patient would receive FK-506 preloading for 3 days prior to nerve transection; this has been shown experimentally to further enhance FK-506’s neuroregenerative effect[78] and has been implemented clinically in elective cases of reconstructive nerve allotransplantation[79]. While this duration of preloading is not possible in hand transplantation due to the unpredictable nature of transplant availability, there is often a window of time on the order of 12 hours, in which the recipient is being notified of and prepared for surgery but the transplant is still being procured and prepared.…”