Immune Response Following Fresh Arterial Homograft Replacement for Aortoiliac Graft Infection

Abstract

fresh arterial homografts are immunogenic. Implanted homografts induce a strong anti-HLA antibody response, similar to chronic rejection, in spite of immunosuppressive treatment.

The Role of Cyclosporine A in the Treatment of Prosthetic Vascular Graft Infections with the Use of Arterial Homografts

“…We chose cold-preserved fresh arterial homografts because we believed the deep-freeze method was more likely to decrease long-term viability of the arterial wall and less likely to cause the degradation of the endothelium (Bujan et al,2000;Desgranges et al,1998;Manaa et al,2003;Pascual et al,2001Pascual et al, , 2002Vischjager et al, 1996aVischjager et al, , 1996b. Some scientists claim that the arterial homograft is characterized by low immunogenity and maintain that the graft rejection process is inconsiderable and does not cause an impaired functioning and survivability of the graft (Mirelli et al, , 1999. This is why some vascular surgery centers transplant the arteries without the selection of ABO and HLA compatible donors.…”

“…However, the endothelium is immunogenic, and thus immunosuppression is needed (Cerilli et al,1985;Methe et al,2007;Paul et al,1985;Pober et al,1984). Moreover, organ donors should be selected with respect to histocompatibility and blood group types Mirelli et al,1998Mirelli et al, , 1999Scolari et al,1998). Experimental studies show that immunosuppressive treatment is helpful after the implantation of cold-preserved fresh arterial homografts (Azuma et al,1999;Gabriel&Fandrich,2002).…”

“…On the other hand, there is a concern that immunosuppressive drugs can exacerbate the infection. There are no clinical studies examining the need to use immunosuppression after the transplantation of fresh arterial homografts in prosthetic graft infections (Mirelli et al,1999). We assumed that administration of Cyclosporine A with a concomitant antibiotic therapy may improve the viability of the fresh arterial homografts and improve the patients' condition.…”

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

“…Thus, the replacements of the infected prostheses by various substitute materials such as i) autologous veins, ii) rifampicin-bonded or silver-coated prostheses or iii) fresh or cryopreserved arterial allografts (homografts) are generally regarded as adequate therapies to overcome this acute life-threatening situation [2,[5][6][7]. The antigenicity of arterial allografts which triggers the humoral immune response in a way similar to processes highly deleterious for solid organ recipients, however, has for years not generally been accepted by vascular surgeons [8]. By contrast it has been known for more than forty years that antibodies which are directed against HLA-antigens of a given donor represent the dominating reason for hyperacute or acute rejections of kidney allografts and allografts of other solid organs [9][10][11].…”

“…Furthermore, only a limited number of studies exist which have investigated the allo-specific immune response induced by arterial allografts, and the majority of them is based on animal models [12][13][14][15][16]. 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 …”