Fresh and Cryopreserved Arterial Homografts: Immunological and Clinical Results

Mirelli, Michele; Buzzi, Marina; Pasquinelli, Gianandrea; Tazzari, Pl; Testi, Gabriele; Ricchi, Ennio; Conte, Roberto; Stella, Andréa

doi:10.1016/j.transproceed.2005.06.034

Cited by 29 publications

(28 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In accordance with the study of Mirelli et al [21] and our investigations the authors furthermore provided evidence that cryopreservation does not lead to a reduced or completely inhibited antigenicity as all their 40 patients in spite of their immune responses were exclusively allografted using cryopreserved vessels [25,26]. In their first publication the authors speculated that a better degree of HLA-matching between donors and recipients may reduce the poor patency rates of vein allograft bypass and the high degree of vein allograft failure [25].…”

Section: Discussionsupporting

confidence: 88%

“…Mirelli and co-workers speculated that this HLA-directed humoral immune response contributed to the implant's degeneration by boosting the narrowing of the vascular lumen. In this context it should be mentioned that until recently this and a consecutive study of Mirelli and co-workers [20,21] were not known to the authors of the present investigations. Thus, although featured by highly concordant results the data of Mirelli and our group's data were as a matter of fact independently collected.…”

Section: Discussionmentioning

confidence: 72%

“…These four donations, however, did not exhibit reduced levels of panel-reactive antibodies nor reduced numbers of donor-specific antibodies (Tables 1 and 2) leading to the conclusion that fresh and cryopreserved arterial homografts are indeed of very similar immunogenicity. Although in that study of Mirelli and coworkers all of the patients were cured from the primary infection one patient died by a rupture of the graft and three patients exhibited stenotic lesions due to chronic rejections during a follow-up period of two years [21]. Interestingly these three patients belonged to the group treated with cyclosporine at a dose of 3-5 mg/kg per day.…”

Section: Discussionmentioning

confidence: 87%

“…In their later study comprising thirty patients Mirelli et al [21] grafted both using fresh (n=23) and cryopreserved (n=7) arterial vessels. Furthermore, patients were divided in two groups one of which (10 patients) received immunosuppressive treatment whereas the second group (20 patients) did not receive any immunosuppressive therapy.…”

Section: Discussionmentioning

confidence: 99%

“…There are only few studies mainly of the 1990s in which the cellular and humoral immune responses as a consequence of venous and especially arterial allo-grafting in humans was investigated [8,[17][18][19][20]. HLA class I and class II antigens, however, well known as pivotal allo-reactive transplantation antigens have been included only in few investigations dealing with arterial allografts [20,21] and are also at present widely neglected among vascular surgeons concerning their influence upon graft function of implanted …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Strong Humoral Anti-HLA Immune Response Upon Arbitrarily Chosen Allogeneic Arterial Vessel Grafts

H¹,

Wahle²,

Altermann³

et al. 2017

J Clin Cell Immunol

View full text Add to dashboard Cite

Forty-three patients were grafted with forty-four fresh or cryopreserved allogeneic arterial vessels in order to treat infections of synthetic vascular implants as these often lead to sepsis, amputation and death. All the patients were HLA-typed whereas typing results of the post-mortem donors were inquired or genotyped from residuary vessels' segments. 84% of the patients were cured from the underlying infections with a re-infection rate of only 9% attesting this therapeutic procedure a high success rate for recovering from the bacterial infections. Since the allografts were chosen without considering HLA-histocompatibility between donors and recipients 95% of the patients developed a humoral anti-HLA immune response with 89% of them giving rise to virtually definable donor-specific antibodies. Regarding the clinical outcome 16% of the patients exhibited thromboses as the most frequent complication. In addition to clinical follow up analyses of all patients, tissue excisions of 11 patients' allografts due to various complications but not resulting from persisting infections were analyzed in order to compare these vessels' pre-and post-transplant histological appearance. In contrast to three early excised homografts (after 14 to 45 days) all of the later on explanted vessels (after 8 to 96 months) clearly showed chronic degeneration processes induced by the alloreactive immune response. Although not leading to acute graft dysfunctions comparable to those of solid organs, arbitrarily selected vessels exhibit a high degree of alloimmunization with consequent chronic degeneration processes such as the loss of smooth muscle cells. Additionally, clear signs of fibrosis of the different arterial vessel layers lead to obliterative arteriopathy and thromboses. Thus, apparently the overall practicability of the unmatched allocation of arterial homografts is clearly limited. Further approaches of arterial vessel allo-grafting are required to investigate the hypothesis that the clinical outcome of well HLA-matched homografts may lead to a significantly decreased number of thromboses.

show abstract