Immunosuppressive treatment of venous allografts

Vermassen, Frank; Degrieck, N.; Kock, Lisa De; J, Goubeau; Landuyt, Koenraad Van; Noens, Lucien; Derom, F

doi:10.1016/s0950-821x(05)80904-1

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…6 The risk for thrombosis is enhanced by rejection, leading to loss of endothelial lining and function, and in a later phase, by immune-related intimal hyperplasia and fibrosis. 7 Even the introduction of immunosuppressive therapy, 8 improvement of harvesting techniques and preservation fluids, 9 and the use of anticoagulation therapy 10 could not improve the patency rate of these allografts in most studies.…”

mentioning

confidence: 99%

“…The choice for cryopreserved human GSV allografts was based on previous experimental work at our department. 7,11 Through careful graft selection, rigorous preservation technique, and adding low-dose immunosuppressive therapy, we hoped to improve the outcome results compared with most published reports. 5 To evaluate our results and for reasons of quality control, we retrospectively reviewed all cryopreserved GSV allografts used as an infrapopliteal conduit and compared the results with those published on venous allografts.…”

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confidence: 99%

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Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Randon

Jacobs

Ryck

et al. 2010

Journal of Vascular Surgery

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Objective: The availability of autologous vein grafts remains the limiting factor in infragenual bypass surgery in many patients with critical limb ischemia (CLI). Alternatives such as prosthetic conduits are known to have a poor outcome and most are not resistant to infection. Based on previous experimental work, we started to use cryopreserved saphenous vein allografts for this indication 15 years ago. To evaluate their outcome, we performed a retrospective study of those bypasses with distal anastomosis on a crural or pedal vessel. Methods: Between November 1991 and December 2005, 108 cryopreserved great saphenous vein allografts were implanted for in 92 patients (42 women, 50 men) with a mean age of 71 years (range, 39-88 years). All patients received low-dose immunosuppressive therapy for up to 1 year after intervention. Follow-up was conducted until amputation, death, or the end of the study in March 2007. Results: Nondiabetic atherosclerosis the cause of CLI in 57%, 41% had diabetes, and 2% had Buerger disease. Forty-one conduits were performed for primary reconstructions and 67 for redo reconstructions. During a mean follow-up of 26.4 months, 69 occlusions occurred. Primary and secondary patency rates were 56% and 73% at 1 year, 32% and 60% at 3 years, and 17% and 38.5% at 5 years. Survival rates were 87.4% at 1 year and 64.5% at 5 years. At multivariate analysis, the intake of statins was predictive for improved patency (hazard ratio [HR], 0.09; P = .024) and for prolonged survival (HR, 0.335; P = .045). The presence of diabetes showed a trend for inferior patency (HR, 2.325; P = .116) and for decreased amputation risk (HR., 0.592; P = .078). Conclusion: Cryopreserved saphenous vein allografts are a valuable alternative to prosthetic materials when autologous veins are not available. Our limb salvage and patency rates are higher then those described for prosthetic grafts at the infrapopliteal level in most studies. Moreover, these grafts are resistant to infection when performed for revascularization in patients with an infected ulcer. Better graft and patient selection, better graft surveillance and immunologic matching, and standard use of statins could possibly improve the results even further. Shortage in availability might be a limiting factor for their widespread use

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confidence: 99%

mentioning

confidence: 99%

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Randon

Jacobs

Ryck

et al. 2010

Journal of Vascular Surgery

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“…In a canine model of inferior caval allovein arterialisation, CyA at 20 mg kg −1 per day reduced aneurysmal dilatation 30 days after transplantation [17]. In other experimental works, the discontinuation of CyA treatment led to the occlusion of venous allografts within 30 days [19].…”

Section: Discussionmentioning

confidence: 89%

“…Neither methylprednisolone nor azathioprine, even in combination with prednisone (at 5 and 2.5 mg kg −1 per day, respectively), were able to inhibit the host immune response and prolong allograft patency rates in a canine model of venous allotransplantation [16,19,20]. Cyclosporine A (CyA) was first used as an immunosuppressant in a canine jugular vein-to-carotid artery allotransplantation model by Bandlien et al in 1983 [21].…”

Section: Discussionmentioning

confidence: 99%

The minimal dose of FK506 is sufficient to facilitate the arterialisation of venous allografts in rats

et al. 2013

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Background We investigated whether a minimal dose of FK506 is sufficient to inhibit the rejection of venous allografts and facilitate allograft adaptation to arterialisation in rats.Methods Iliolumbar veins from Brown Norway (BN) rats were transplanted into the abdominal aorta of Lewis (LEW) rats. Recipient animals received daily intramuscular injections of 0.1 mg kg −1 FK506. Light microscope evaluations of grafts were performed 30 days after transplantation. We investigated the presence of endothelial cells, the intensity of intimal proliferation, the deposition of immunoglobulin G molecules into the medial layer and the degree of adventitial infiltration by Lewis MHC class II-positive, CD4-positive and CD8-positive cells. All results were compared to previously reported data for syngeneic, allogeneic non-immunosuppressed and allogeneic FK506-low-dose immunosuppressed animals.Results All alloveins under minimal FK506 immunosuppression showed typical histological signs of arterialisation 30 days after transplantation. Intimal thickness (15.1 ± 6.1 µm) and the degree of adventitial infiltration by MHC class II-positive (16.96 ± 10.46), CD8-positive (2.63 ± 2.6), and CD4-positive (7.67 ± 8.29) cells were not significantly different when compared to untreated syngeneic veins and allogeneic veins treated with a low dose of FK506, respectively.Conclusions Even the minimal dose of FK506 was sufficient to inhibit the acute rejection of venous allografts and to facilitate allograft arterialisation 30 days after transplantation.

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“…However, there is still a question of whether or not to use these drugs in the presence of the infection. Prolonged functioning of the arterial graft in patients treated with the immunosuppressive drugs was confirmed in some experimental trails (Deaton et al,1992;Miller et al,1993;Vermassen et al,1991;. In his experimental trial, Azuma et al observed that lack or discontinuation of the intake of immunosuppressive medications caused the degradation of the arterial graft's wall and loss of the endothelial cells (Azuma et al,1999).…”

Section: Discussionmentioning

confidence: 95%

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

Pupka¹,

Płonek²

2012

Immunosuppression - Role in Health and Diseases

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Immunosuppressive treatment of venous allografts

Cited by 14 publications

References 16 publications

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

Fifteen years of infrapopliteal arterial reconstructions with cryopreserved venous allografts for limb salvage

The minimal dose of FK506 is sufficient to facilitate the arterialisation of venous allografts in rats

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

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