The transmission of disease to allograft recipients via donor organs

Autograft Versus Allograft Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Clinical Study With a Minimum 10-Year Follow-up

BACKGROUND

The use of allografts for anterior cruciate ligament (ACL) reconstruction in young athletes is controversial. No long-term results have been published comparing tibialis posterior allografts to hamstring autografts.

PURPOSE

To evaluate the long-term results of primary ACL reconstruction using either an allograft or autograft.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

From June 2002 to August 2003, patients with a symptomatic ACL-deficient knee were randomized to receive either a hamstring autograft or tibialis posterior allograft. All allografts were from a single tissue bank, aseptically processed, and fresh-frozen without terminal irradiation. Graft fixation was identical in all knees. All patients followed the same postoperative rehabilitation protocol, which was blinded to the therapists. Preoperative and postoperative assessments were performed via examination and/or telephone and Internet-based questionnaire to ascertain the functional and subjective status using established knee metrics. The primary outcome measures were graft integrity, subjective knee stability, and functional status.

RESULTS

There were 99 patients (100 knees); 86 were men, and 95% were active-duty military. Both groups were similar in demographics and preoperative activity level. The mean and median ages of both groups were identical at 29 and 26 years, respectively. Concomitant meniscal and chondral pathologic abnormalities, microfracture, and meniscal repair performed at the time of reconstruction were similar in both groups. At a minimum of 10 years (range, 120-132 months) from surgery, 96 patients (97 knees) were contacted (2 patients were deceased, and 1 was unable to be located). There were 4 (8.3%) autograft and 13 (26.5%) allograft failures that required revision reconstruction. In the remaining patients whose graft was intact, there was no difference in the mean Single Assessment Numeric Evaluation, Tegner, or International Knee Documentation Committee scores.

CONCLUSION

At a minimum of 10 years after ACL reconstruction in a young athletic population, over 80% of all grafts were intact and had maintained stability. However, those patients who had an allograft failed at a rate over 3 times higher than those with an autograft.

Technique for the harvesting of human cadaveric spines

STUDY DESIGN

One hundred twelve fresh cadaveric spines were harvested using a newly described technique.

OBJECTIVES

To develop and describe a technique for the expeditious excision of intact human cadaveric spines for biomechanical testing, to educate the dissector on the health and safety issues involved in harvesting spinal specimens, and to review the present recommendations for storage and preservation of spinal segments.

SUMMARY OF THE BACKGROUND DATA

As the need for biomechanical spinal research continues to expand, the demand for fresh human cadaveric vertebral specimens increases. Previous techniques for harvesting are simplistic and sparse. This technique offers a reliable and expeditious method for procurement of spinal vertebral segments of any size.

METHODS

Human cadaveric spines were harvested using an adaptation of previous posterior spinal approaches. Techniques for sectioning each vertebral region were developed. Detailed description of these techniques was meticulously documented. The procured spinal segments have been used for multiple biomechanical investigations.

RESULTS

The technique has been used successfully in more than 100 spinal harvests. Approximate time required is 30 minutes. The harvested segments have been reliable biomechanical specimens in many published studies.

CONCLUSIONS

A new technique for the rapid extraction of human cadaveric spines has been developed. Dissectors may benefit from the recommendations offered for sectioning of each region.

Advanced donor-origin melanoma in a renal transplant recipient: immunotherapy, cure, and retransplantation

BACKGROUND

A kidney transplant recipient inadvertently contracted donor-origin melanoma, which was found to be very advanced at presentation. Withdrawal of immunosuppression failed to induce rejection, and interferon-alpha was required. When florid allograft rejection was in progress, the allograft was removed, before it was recognized that the transplanted melanoma was not being simultaneously rejected.

METHODS

Subsequent immunotherapy was required, which largely recapitulated treatment of recognized value in autologous melanoma and included interferon-alpha, use of cultured melanoma cells as tumor vaccine, pooled allogeneic cell vaccination, and adoptive immunotherapy using lymphokine-activated killer cells.

RESULTS

Prolonged immunotherapy eradicated the widespread malignancy, and the patient went on to a successful second renal transplant, with follow-up of over 24 months.

CONCLUSIONS

This unique case demonstrates the successful cure of advanced transplanted melanoma through the use of immunotherapy, which did not require sophisticated tumor vaccine technology, and successful retransplantation.