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Ebner A, Gallo S, Castellano J, Filartiga M, Haarstad A, Pries C, Gahlbeck K, McMahon M, Herrera C, Avila M, Schankereli K, Murphy R, Stenoien M, Syedain Z, Wasse H. First-in-human evaluation of a biological regenerative vascular conduit for hemodialysis access. J Vasc Access 2024; 25:1271-1278. [PMID: 36895135 DOI: 10.1177/11297298221147709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
INTRODUCTION The long-term survival and low complication rate of autogenous fistulas for hemodialysis access is often offset by early thrombosis and slow or failed maturation leading to the use of central venous catheters. A regenerative material may have the potential to overcome these limitations. A completely biological acellular vascular conduit was investigated in this first-in-human clinical study. METHODS With approval of the ethics board and patients' informed consent, five subjects were enrolled based on predetermined inclusion criteria. Five patients underwent implant of a novel acellular, biological tissue conduit (TRUE AVC™) in the upper arm in a curved configuration between brachial artery and axillary vein. After maturation, standard dialysis was commenced through the new access. Patients were followed up to 26 weeks with ultrasound and physical exam. Serum samples were evaluated for an immune response to the novel allogeneic human tissue implant. RESULTS This new tissue conduit handled well surgically, with properties similar to that of native human vein. Post procedure conduit flow was excellent in all cases, averaging 1098 ± 388 ml/min at week 4 and remaining stable through 1248 ± 355 ml/min at 26 weeks. Surgical site healing was normal with no edema or erythema by week 4. Six-month primary assisted patency was 80% and secondary patency was 100%. Prescribed dialysis was successfully delivered without infection, and there was no significant change in conduit diameter. Serum testing showed no increase in PRA or IgG specific to the TRUE AVC. One implant required intervention at 5 months with thrombectomy and covered stent procedure. CONCLUSION This first-in-human 6-month study with favorable patency and low complication rate establishes the initial safety and feasibility of this novel biological tissue conduit for dialysis access in patients with end-stage kidney disease. Its mechanical durability and lack of immune response establishes TRUE AVC as a potential regenerative material for clinical use.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Zeeshan Syedain
- Vascudyne, Inc., St. Paul, MN, USA
- University of Minnesota, Minneapolis, MN, USA
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Wonski BT, Patel B, Tepper DG, Siddiqui A, Kabbani LS, Lam MT. Adipose-derived stem cells significantly increases collagen level and fiber maturity in patient-specific biological engineered blood vessels. PLoS One 2023; 18:e0291766. [PMID: 37738272 PMCID: PMC10516413 DOI: 10.1371/journal.pone.0291766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Tissue engineering has driven significant research in the strive to create a supply of tissues for patient treatment. Cell integration into engineered tissues maximizes functional capabilities, however, issues of rejection remain. Autologous cell sources able to solve this issue are difficult to identify for tissue engineering purposes. Here, we present the efficacy of patient-sourced cells derived from adipose (adipose-derived stem cells, ASCs) and skin tissue (dermal fibroblasts, PtFibs) to build a combined engineered tunica media and adventitia graft, respectively. Patient cells were integrated into our lab's vascular tissue engineering technique of forming vascular rings that are stacked into a tubular structure to create the vascular graft. For the media layer, ASCs were successfully differentiated into the smooth muscle phenotype using angiotensin II followed by culture in smooth muscle growth factors, evidenced by significantly increased expression of αSMA and myosin light chain kinase. Engineered media vessels composed of differentiated ASCs (ASC-SMCs) exhibited an elastic modulus (45.2 ± 18.9 kPa) between that of vessels of undifferentiated ASCs (71.8 ± 35.3 kPa) and control human aortic smooth muscle cells (HASMCs; 18.7 ± 5.49 kPa) (p<0.5). Tensile strength of vessels composed of ASCs (41.3 ± 15.7 kPa) and ASC-SMCs (37.3 ± 17.0 kPa) were higher compared to vessels of HASMCs (28.4 ± 11.2 kPa). ASC-based tissues exhibited a significant increase in collagen content and fiber maturity- both factors contribute to tissue strength and stability. Furthermore, vessels gained stability and a more-uniform single-tubular shape with longer-term 1-month culture. This work demonstrates efficacy of ASCs and PtFibs to create patient-specific vessels.
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Affiliation(s)
- Bryan T. Wonski
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, United States of America
| | - Bijal Patel
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, United States of America
| | - Donna G. Tepper
- Department of Plastic and Reconstructive Surgery, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Aamir Siddiqui
- Department of Plastic and Reconstructive Surgery, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Loay S. Kabbani
- Department of Vascular Surgery, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Mai T. Lam
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, United States of America
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3
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He B, Musk GC, Ng ZQ, Kershaw H, DeBoer B, Hamdorf JM. Investigation of a method for long-term preservation of the vascular allograft. Vascular 2021; 30:568-576. [PMID: 33966508 DOI: 10.1177/17085381211012945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/OBJECTIVE During multiple organ procurement, blood vessels are routinely retrieved and stored in University of Wisconsin solution and then discarded after two weeks, if not used at organ transplantation owing to lack of a method for long-term preservation. Therefore, the aim of this study is to investigate a method for long-term preservation of vascular allografts in ethanol. METHODS Aorta and vena cava allografts were retrieved and stored in 75% ethanol solution for 12 months at 4°C. Four pigs were divided into two groups. A segment of aorta was excised and replaced by insertion of preserved aorta graft (Group A) or vena cava graft (Group V). The pigs were observed for six weeks. A laparotomy was performed and the vascular graft was harvested for histopathology followed by euthanasia at the end of study. RESULTS Three pigs recovered uneventfully, while one pig died from venous graft rupture in the third week after surgery. There was no aneurysmal formation or thrombosis in the grafts. Some calcification was seen over aorta allograft. On histopathology, the elastic pattern was almost normal, although the endothelial cells degenerated after preservation. After implantation, the formation of the endothelium cell-like layer was seen in both aorta and vena cava allografts. CONCLUSION Vascular allografts were functional after preservation for 12 months. The vena cava grafts had much less wall calcification than the aorta grafts. Further studies are necessary to investigate vascular graft remodelling with a longer observation period after implantation.
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Affiliation(s)
- Bulang He
- Medical School, The University of Western Australia, Crawley, WA, Australia.,Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - Zi Qin Ng
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Helen Kershaw
- Animal Care Services, The University of Western Australia, Crawley, WA, Australia
| | | | - Jeffrey M Hamdorf
- Medical School, The University of Western Australia, Crawley, WA, Australia
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Kalinin R, Suchkov I, Egorov A, Karpov V, Klimentova E, Karpov D. Permanent vascular access for hemodialysis using allogeneic vein. KARDIOLOGIYA I SERDECHNO-SOSUDISTAYA KHIRURGIYA 2021; 14:98. [DOI: 10.17116/kardio20211401198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
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5
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González-Gay M, López-Martínez R, Busto-Suárez S, Riedemann-Wistuba ME, Menéndez-Herrero MÁ, Álvarez-Marcos F, Alonso-Pérez M, Alonso-Arias R. Immunological Aspects Involved in the Degeneration of Cryopreserved Arterial Allografts. Front Surg 2020; 7:616654. [PMID: 33415125 PMCID: PMC7783309 DOI: 10.3389/fsurg.2020.616654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/23/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: Cryopreserved arterial allografts have remained an option in patients requiring distal revascularization or associated with vascular infection, in the absence of a valid autogenous saphenous vein. The objective of this study is to describe the different clinical, anatomopathological, and immunological findings related to vascular transplant rejection. Methods: In a prospective trial, 35 patients who underwent cryopreserved allogeneic arterial bypass were studied, including demographics and conduit patency. Anti-HLA antibody production was stablished prior to the surgery, 7 days, 1, 3 months, and every 3 months since. Clinical and ultrasound evaluation was added after the first month. Donor HLA-typing was retrieved whenever available, allowing for the characterization and quantification of donor specific antibodies. Cytotoxic crossmatch test was also performed. A second group of patients with allograft degenerations registered during the follow up period was studied. In this group, exclusively for aneurysm description and histopathological analysis, they were included those degenerated vascular transplants from the original series, but also those implanted prior to the beginning of the study and degraded during follow up. Results: All patients studied displayed an increase in anti-HLA antibodies one month after the intervention, regarding bypass patency. In total, 14 patients fulfilled requirements for the study of donor specific antibodies, equally showing IgG production detectable one month after surgery. The presence of complement-fixing antibodies was also confirmed. Antibody levels were not related to graft degeneration. No specific immune markers able to predict aneurysmal development and evolution were found. From the original group, 3 patients suffered aneurysmal degeneration during follow up, together with 9 bypasses previously implanted. Average time until the first degeneration was 33 ± 19.7 months, with 30.6 ± 17.7 and 54.5 ± 2.5 months for a second and third degeneration, when occurring. Therefore, subsequent vascular transplants frequently augmented the time for new degenerations, despite increasing sensibilization. Samples from eight degenerated allografts were available for analysis, unexpectedly showing inflammatory infiltrate in only four cases and immune complex deposition in 7. Conclusions: Immune response against vascular transplants was confirmed in all cases, but chronic rejection did not necessarily provoke bypass degradation or reduced the time for new aneurysms to develop in subsequent allografts.
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Affiliation(s)
- Mario González-Gay
- Department of Angiology and Vascular Surgery, Central University Hospital of Asturias, Oviedo, Spain
| | - Rocío López-Martínez
- Department of Immunology, Central University Hospital of Asturias, Oviedo, Spain
| | - Sara Busto-Suárez
- Department of Angiology and Vascular Surgery, Central University Hospital of Asturias, Oviedo, Spain
| | | | | | - Francisco Álvarez-Marcos
- Department of Angiology and Vascular Surgery, Central University Hospital of Asturias, Oviedo, Spain
| | - Manuel Alonso-Pérez
- Department of Angiology and Vascular Surgery, Central University Hospital of Asturias, Oviedo, Spain
| | - Rebeca Alonso-Arias
- Department of Immunology, Central University Hospital of Asturias, Oviedo, Spain
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6
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Abstract
Since the advent of the vascular anastomosis by Alexis Carrel in the early 20th century, the repair and replacement of blood vessels have been key to treating acute injuries, as well as chronic atherosclerotic disease. Arteries serve diverse mechanical and biological functions, such as conducting blood to tissues, interacting with the coagulation system, and modulating resistance to blood flow. Early approaches for arterial replacement used artificial materials, which were supplanted by polymer fabrics in recent decades. With recent advances in the engineering of connective tissues, including arteries, we are on the cusp of seeing engineered human arteries become mainstays of surgical therapy for vascular disease. Progress in our understanding of physiology, cell biology, and biomanufacturing over the past several decades has made these advances possible.
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Affiliation(s)
- Laura E Niklason
- Departments of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT, USA. .,Humacyte Inc., Durham, NC 27713, USA
| | - Jeffrey H Lawson
- Humacyte Inc., Durham, NC 27713, USA. .,Department of Surgery, Duke University, Durham, NC, USA
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7
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Bai H, Wang Z, Li M, Sun P, Wang W, Liu W, Wei S, Wang Z, Xing Y, Dardik A. A rat arteriovenous graft model using decellularized vein. Vascular 2020; 28:664-672. [PMID: 32390561 DOI: 10.1177/1708538120923191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The high rate of clinical failure of prosthetic arteriovenous grafts continues to suggest the need for novel tissue-engineered vascular grafts. We tested the hypothesis that the decellularized rat jugular vein could be successfully used as a conduit and that it would support reendothelialization as well as adaptation to the arterial environment. MATERIALS AND METHODS Autologous (control) or heterologous decellularized jugular vein (1 cm length, 1 mm diameter) was sewn between the inferior vena cava and aorta as an arteriovenous graft in Wistar rats. Rats were sacrificed on postoperative day 21 for examination. RESULTS All rats survived, and grafts had 100% patency in both the control and decellularized groups. Both control and decellularized jugular vein grafts showed similar rates of reendothelialization, smooth muscle cell deposition, macrophage infiltration, and cell turnover. The outflow veins distal to the grafts showed similar adaptation to the arteriovenous flow. Both CD34, CD90 and nestin positive cells, as well as M1-type and M2-type macrophages accumulated around the graft. CONCLUSIONS This model shows that decellularized vein can be successfully used as an arteriovenous graft between the rat aorta and the inferior vena cava. Several types of cells, including progenitor cells and macrophages, are present in the host response to these grafts in this model. This model can be used to test the application of arteriovenous grafts before conducting large animal experiments.
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Affiliation(s)
- Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China.,Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Mingxing Li
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Peng Sun
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Wang Wang
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China.,Department of Physiology, Medical school of Zhengzhou University, Henan, China
| | - Weizhen Liu
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China.,Department of Physiology, Medical school of Zhengzhou University, Henan, China
| | - Shunbo Wei
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhiju Wang
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China.,Department of Physiology, Medical school of Zhengzhou University, Henan, China
| | - Ying Xing
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China.,Department of Physiology, Medical school of Zhengzhou University, Henan, China
| | - Alan Dardik
- The Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT, USA.,Department of Surgery and of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
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8
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Kirkton RD, Santiago-Maysonet M, Lawson JH, Tente WE, Dahl SLM, Niklason LE, Prichard HL. Bioengineered human acellular vessels recellularize and evolve into living blood vessels after human implantation. Sci Transl Med 2020; 11:11/485/eaau6934. [PMID: 30918113 DOI: 10.1126/scitranslmed.aau6934] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Abstract
Traditional vascular grafts constructed from synthetic polymers or cadaveric human or animal tissues support the clinical need for readily available blood vessels, but often come with associated risks. Histopathological evaluation of these materials has shown adverse host cellular reactions and/or mechanical degradation due to insufficient or inappropriate matrix remodeling. We developed an investigational bioengineered human acellular vessel (HAV), which is currently being studied as a hemodialysis conduit in patients with end-stage renal disease. In rare cases, small samples of HAV were recovered during routine surgical interventions and used to examine the temporal and spatial pattern of the host cell response to the HAV after implantation, from 16 to 200 weeks. We observed a substantial influx of alpha smooth muscle actin (αSMA)-expressing cells into the HAV that progressively matured and circumferentially aligned in the HAV wall. These cells were supported by microvasculature initially formed by CD34+/CD31+ cells in the neoadventitia and later maintained by CD34-/CD31+ endothelial cells in the media and lumen of the HAV. Nestin+ progenitor cells differentiated into either αSMA+ or CD31+ cells and may contribute to early recellularization and self-repair of the HAV. A mesenchymal stem cell-like CD90+ progenitor cell population increased in number with duration of implantation. Our results suggest that host myogenic, endothelial, and progenitor cell repopulation of HAVs transforms these previously acellular vessels into functional multilayered living tissues that maintain blood transport and exhibit self-healing after cannulation injury, effectively rendering these vessels like the patient's own blood vessel.
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Affiliation(s)
| | | | - Jeffrey H Lawson
- Humacyte Inc., Durham, NC 27713, USA.,Departments of Surgery and Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | - Laura E Niklason
- Humacyte Inc., Durham, NC 27713, USA.,Departments of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT 06511, USA
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9
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Jahnukainen T, Lauronen J, Raissadati A, Pihkala JI, Ylinen E, Puntila JT, Salminen JT, Pätilä T, Mattila IP, Jalanko HJ. Development of Human Leukocyte Antigen (HLA) Antibodies Against Vascular Homograft Donor in Pediatric Heart Transplant Recipients. Ann Transplant 2019; 24:454-460. [PMID: 31383839 PMCID: PMC6698089 DOI: 10.12659/aot.917232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The appearance of human leukocyte antigen (HLA) antibodies after solid organ transplantation predisposes recipients to graft dysfunction. In theory, vascular homografts, which are widely used in children with congenital heart defects, may cause allosensitization. Material/Methods In this single-center retrospective study, the presence of pre-existing HLA antibodies in pediatric heart transplant (HTx) recipients with a vascular homograft was evaluated in a cohort of 12 patients. HLA antibodies were screened before and after HTx and positive screening results were confirmed and identified using the Luminex® single antigen bead method. Endomyocardial biopsies (EMB) and coronary angiography studies were re-evaluated to assess the prevalence of acute rejections and coronary artery change in these patients. Results At the time of HTx, 8 patients (67%) had HLA antibodies detected by the Luminex assay, none of which were heart donor specific (DSA). All patients had negative leukocyte crossmatch. One patient developed DSAs against homograft donor prior to HTx. After the HTx, 5 patients (42%) developed DSAs against the heart donor and 4 patients (40%) against the homograft donor. In 2 patients (17%), the antibodies were against both heart and homograft donors. The rejection rate or prevalence of coronary artery vasculopathy did not differ significantly between the homograft cohort and our historical controls. Conclusions Our results suggest that the prevalence of DSAs against homograft donor prior to HTx is relatively rare. However, almost half of the patients developed DSAs against homograft post-HTx. The clinical importance of these antibodies warrants further studies.
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Affiliation(s)
- Timo Jahnukainen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Alireza Raissadati
- Department of Pediatric Cardiology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana I Pihkala
- Department of Pediatric Cardiology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Elisa Ylinen
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Tapani Puntila
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka T Salminen
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tommi Pätilä
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka P Mattila
- Department of Pediatric Surgery, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Jaakko Jalanko
- Department of Pediatric Nephrology and Transplantation, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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10
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Aldridge A, Desai A, Owston H, Jennings LM, Fisher J, Rooney P, Kearney JN, Ingham E, Wilshaw SP. Development and characterisation of a large diameter decellularised vascular allograft. Cell Tissue Bank 2018; 19:287-300. [PMID: 29188402 PMCID: PMC6133183 DOI: 10.1007/s10561-017-9673-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022]
Abstract
The aims of this study were to develop a biological large diameter vascular graft by decellularisation of native human aorta to remove the immunogenic cells whilst retaining the essential biomechanical, and biochemical properties for the ultimate benefit of patients with infected synthetic grafts. Donor aortas (n = 6) were subjected to an adaptation of a propriety decellularisation process to remove the cells and acellularity assessed by histological analysis and extraction and quantification of total DNA. The biocompatibility of the acellular aortas was determined using standard contact cytotoxicity tests. Collagen and denatured collagen content of aortas was determined and immunohistochemistry was used to determine the presence of specific extracellular matrix proteins. Donor aortas (n = 6) were divided into two, with one half subject to decellularisation and the other half retained as native tissue. The native and decellularised aorta sections were then subject to uniaxial tensile testing to failure [axial and circumferential directions] and suture retention testing. The data was compared using a paired t-test. Histological evaluation showed an absence of cells in the treated aortas and retention of histoarchitecture including elastin content. The decellularised aortas had less than 15 ng mg-1 total DNA per dry weight (mean 94% reduction) and were biocompatible as determined by in vitro contact cytotoxicity tests. There were no gross changes in the histoarchitecture [elastin and collagen matrix] of the acellular aortas compared to native controls. The decellularisation process also reduced calcium deposits within the tissue. The uniaxial tensile and suture retention testing revealed no significant differences in the material properties (p > 0.05) of decellularised aorta. The decellularisation procedure resulted in minimal changes to the biological and biomechanical properties of the donor aortas. Acellular donor aorta has excellent potential for use as a large diameter vascular graft.
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Affiliation(s)
- A Aldridge
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, The University of Leeds, Leeds, LS2 9JT, UK.
| | - A Desai
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
| | - H Owston
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, The University of Leeds, Leeds, LS2 9JT, UK
| | - L M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
| | - J Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, The University of Leeds, Leeds, LS2 9JT, UK
| | - P Rooney
- NHS Blood and Transplant Tissue and Eye Services, 14 Estuary Banks, Estuary Commerce Park, Speke, Liverpool, L24 8RB, UK
| | - J N Kearney
- NHS Blood and Transplant Tissue and Eye Services, 14 Estuary Banks, Estuary Commerce Park, Speke, Liverpool, L24 8RB, UK
| | - E Ingham
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, The University of Leeds, Leeds, LS2 9JT, UK
| | - S P Wilshaw
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, The University of Leeds, Leeds, LS2 9JT, UK
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11
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Sadaghianloo N, Albano L, Pourtein M. Regarding "Cryopreserved venous allograft is an acceptable conduit in patients with current or prior angioaccess graft infection". J Vasc Surg 2018; 67:680-681. [PMID: 29389432 DOI: 10.1016/j.jvs.2017.08.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Nirvana Sadaghianloo
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Nice (University Hospital of Nice), Nice, France; Department of Medicine, Université Nice Côte d'Azur, Nice, France
| | - Laetitia Albano
- Department of Nephrology-Dialysis-Transplantation, Centre Hospitalier Universitaire de Nice (University Hospital of Nice), Nice, France
| | - Monique Pourtein
- Department of Immunology, Centre Hospitalier Universitaire de Nice (University Hospital of Nice), Nice, France
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12
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Alloimmunization After Cryopreserved Arterial Allografts in a Patient on a Kidney Transplantation Waiting List. Transplantation 2017. [PMID: 28640792 DOI: 10.1097/tp.0000000000001783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Ha TY, Kim YH, Chang JW, Park Y, Han Y, Kwon H, Kwon TW, Han DJ, Cho YP, Lee SG. Clinical Outcomes of Cryopreserved Arterial Allograft Used as a Vascular Conduit for Hemodialysis. J Korean Med Sci 2016; 31:1266-72. [PMID: 27478338 PMCID: PMC4951557 DOI: 10.3346/jkms.2016.31.8.1266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 04/12/2016] [Indexed: 12/02/2022] Open
Abstract
This single center cohort study aimed to test the hypothesis that use of a cryopreserved arterial allograft could avoid the maturation or healing process of a new vascular access and to evaluate the patency of this technique compared with that of vascular access using a prosthetic graft. Between April 2012 and March 2013, 20 patients underwent an upper arm vascular access using a cryopreserved arterial allograft for failed or failing vascular accesses and 53 using a prosthetic graft were included in this study. The mean duration of catheter dependence, calculated as the time interval from upper arm access placement to removal of the tunneled central catheter after successful cannulation of the access, was significantly longer for accesses using a prosthetic graft than a cryopreserved arterial allograft (34.4 ± 11.39 days vs. 4.9 ± 8.5 days, P < 0.001). In the allograft group, use of vascular access started within 7 days in 16 patients (80%), as soon as from the day of surgery in 10 patients. Primary (unassisted; P = 0.314) and cumulative (assisted; P = 0.673) access survivals were similar in the two groups. There were no postoperative complications related to the use of a cryopreserved iliac arterial allograft except for one patient who experienced wound hematoma. In conclusion, upper arm vascular access using a cryopreserved arterial allograft may permit immediate hemodialysis without the maturation or healing process, resulting in access survival comparable to that of an access using a prosthetic graft.
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Affiliation(s)
- Tae-Yong Ha
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jai Won Chang
- Department of Internal Medicine University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Yangsoon Park
- Department of Pathology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Youngjin Han
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyunwook Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Tae-Won Kwon
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Duck Jong Han
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Yong-Pil Cho
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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14
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Kleive D, Berstad AE, Verbeke CS, Haugvik SP, Gladhaug IP, Line PD, Labori KJ. Cold-stored cadaveric venous allograft for superior mesenteric/portal vein reconstruction during pancreatic surgery. HPB (Oxford) 2016; 18:615-22. [PMID: 27346143 PMCID: PMC4925797 DOI: 10.1016/j.hpb.2016.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/08/2016] [Accepted: 05/21/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND SMV/PV resection has become common practice in pancreatic surgery. The aim of this study was to evaluate the technical feasibility and surgical outcome of using cold-stored cadaveric venous allografts (AG) for superior mesenteric vein (SMV) and portal vein (PV) reconstruction during pancreatectomy. METHODS Patients who underwent pancreatic resection with concomitant vascular resection and reconstruction with AG between January 2006 and December 2014 were identified from our institutional prospective database. Medical records and pre- and postoperative CT-images were reviewed. RESULTS Forty-five patients underwent SMV/PV reconstruction with AG interposition (n = 37) or AG patch (n = 8). The median operative time and blood loss were 488 min (IQR: 450-551) and 900 ml (IQR: 600-2000), respectively. Major morbidity (Clavien ≥ III) occurred in 16 patients. Four patients were reoperated (thrombosis n = 2, graft kinking/low flow n = 2) and in-hospital mortality occurred in two patients. On last available CT scan, 3 patients had thrombosis, all of whom also had local recurrence. Estimated cumulative patency rate (reduction in SMV/PV luminal diameter <70% and no thrombosis) at 12 months was 52%. CONCLUSION Cold-stored cadaveric venous AG for SMV/PV reconstruction during pancreatic surgery is safe and associated with acceptable long-term patency.
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Affiliation(s)
- Dyre Kleive
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Correspondence: Dyre Kleive, Nydalen, 0424, Oslo, Norway. Tel: +47 23070000. Fax: +47 23072526.NydalenOslo0424Norway
| | | | - Caroline S. Verbeke
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sven P. Haugvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway,Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ivar P. Gladhaug
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål-Dag Line
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut J. Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
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15
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Operative and perioperative management of infected arteriovenous grafts. J Vasc Access 2016; 18:13-21. [DOI: 10.5301/jva.5000613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 11/20/2022] Open
Abstract
Vascular graft infections are a particularly troublesome complication for dialysis patients, many of whom are in an already immunocompromised state. The objective of this review is to detail the risk factors, etiology, diagnosis, perioperative and operative management of vascular graft infections.
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16
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Long-Term Results of Biological Grafts for Haemodialysis Vascular Access. J Vasc Access 2015; 16 Suppl 9:S82-6. [DOI: 10.5301/jva.5000355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/20/2022] Open
Abstract
The quest for suitable conduits for dialysis access has continued since the first patients were dialysed. Whilst synthetic grafts made from expanded polytetrafluoroethylene (ePTFE) have been the main definitive option after autologous arteriovenous fistulas they have a number of drawbacks, which has led to the use and development of biological grafts such as autografts, homografts or xenografts. Technology continues to improve and currently biosynthetic options are available which may combine the benefits of a readily available product without the drawbacks of PTFE. The history and evidence of biological options for haemodialysis access are discussed.
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17
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Boulland LML, Naper C, Skauby MH. Presensitization revisited: pitfalls of vascular allografts in transplant candidates. Clin Kidney J 2013; 7:65-67. [PMID: 24466426 PMCID: PMC3901039 DOI: 10.1093/ckj/sft145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/12/2013] [Indexed: 11/13/2022] Open
Abstract
Vascular allografts in end-stage renal disease (ESRD) patients represent a particular immunological challenge. A broad HLA immunization led us to study in depth the history of two patients with vascular allografts. In Case 1 the allograft was added to a Gore-Tex graft used for haemodialysis access and no immunosuppression was administered. In Case 2 the allograft was used to prolong a renal artery from living donor and immunosuppression was suboptimal. In vascular surgery, immunosuppression is mainly used to improve graft patency. ESRD patients are potential organ recipients and immunosuppression should therefore be tailored to reduce HLA immunization.
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Affiliation(s)
- Line M L Boulland
- Department of Transplant Medicine , Oslo University Hospital , Oslo , Norway
| | - Christian Naper
- Institute of Immunology , Oslo University Hospital , Oslo , Norway
| | - Morten H Skauby
- Department of Transplant Medicine , Oslo University Hospital , Oslo , Norway
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18
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Wystrychowski W, McAllister TN, Zagalski K, Dusserre N, Cierpka L, L'Heureux N. First human use of an allogeneic tissue-engineered vascular graft for hemodialysis access. J Vasc Surg 2013; 60:1353-1357. [PMID: 24103406 DOI: 10.1016/j.jvs.2013.08.018] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 08/07/2013] [Accepted: 08/14/2013] [Indexed: 01/14/2023]
Abstract
An arteriovenous fistula is the current gold standard for chronic hemodialysis access. Tunneled catheters or synthetic grafts have poorer outcomes and much higher risks of infection. This report presents the first clinical use of a completely biological, allogeneic, nonliving, and human tissue-engineered vascular graft. Tissue-engineered vascular grafts built from allogeneic fibroblasts were implanted as shunts in three hemodialysis patients. The tissue-engineered vascular graft was stored for 9 months, without loss of mechanical strength. Implanted grafts showed no signs of degradation or dilation, with time points up to 11 months. Results of panel-reactive antibody and cross-reactivity tests showed no evidence of immune responses.
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Affiliation(s)
- Wojciech Wystrychowski
- Department of General, Vascular, and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | | | - Krzysztof Zagalski
- Department of General, Vascular, and Transplant Surgery, Medical University of Silesia, Katowice, Poland
| | | | - Lech Cierpka
- Department of General, Vascular, and Transplant Surgery, Medical University of Silesia, Katowice, Poland
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19
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Wilshaw SP, Rooney P, Berry H, Kearney JN, Homer-Vanniasinkam S, Fisher J, Ingham E. Development and Characterization of Acellular Allogeneic Arterial Matrices. Tissue Eng Part A 2012; 18:471-83. [DOI: 10.1089/ten.tea.2011.0287] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stacy-Paul Wilshaw
- Faculty of Biological Sciences, Institute of Medical and Biological Engineering, The University of Leeds, Leeds, United Kingdom
| | - Paul Rooney
- NHS Blood and Transplant Tissue Services, National Blood Service, Liverpool, United Kingdom
| | - Helen Berry
- Tissue Regenix Ltd, The Biocentre, York, United Kingdom
| | | | | | - John Fisher
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, The University of Leeds, Leeds, United Kingdom
| | - Eileen Ingham
- Faculty of Biological Sciences, Institute of Medical and Biological Engineering, The University of Leeds, Leeds, United Kingdom
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20
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Allogenous vein graft as vascular access for hemodialysis--lost battle? J Vasc Access 2012; 13:366-73. [PMID: 22367646 DOI: 10.5301/jva.5000062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this paper is to assess a long-term outcome of allogenous vein grafts (ALVG) as vascular access for hemodialysis. MATERIALS AND METHODS For nearly eight years (between 9/2002 and 9/2011) a total of 78 patients with 112 ALVGs were involved in the study. The register included 46 women and 32 men, mean age 66.1 ± 11.2 years; range 20-88 years. The patient database was retrospectively reviewed and statistical processing was performed. RESULTS Almost all ALVGs were treated by PTA or surgically, very often repeatedly. The number of radiologic interventions was 316, the number of surgical procedures 31. Mean follow-up time was 795 days, range 28-3522 days. Thirty-five patients died of unrelated causes, nineteen with functional graft, fourteen patients were lost to follow-up. Forty ALVGs failed for various reasons, mostly because of occlusion. Only one patient underwent successful renal transplantation, no patient converted to peritoneal dialysis. Thirty-seven ALVGs remain correctly functioning. Primary patency rates at 6, 12, and 24 months were 81 ± 5%, 63 ± 5%, and 34 ± 2% respectively. Secondary patency rates at 6, 12, and 24 months were 96 ± 2%, 82 ± 4%, and 65 ± 5% respectively. CONCLUSIONS Allogenous vein grafts, in spite of the high number of necessary radiologic and surgical interventions and reinterventions, show acceptable clinical usability and durability, comparable with other types of prosthetic grafts.
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21
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Dahl SL, Blum JL, Niklason LE. Bioengineered Vascular Grafts: Can We Make Them Off-the-Shelf? Trends Cardiovasc Med 2011; 21:83-9. [DOI: 10.1016/j.tcm.2012.03.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Liu Z, Zhu B, Wang X, Jing Y, Wang P, Xu H. Reduced antigenicity of formaldehyde-fixed arterial allografts and their potential clinical application. Transplant Proc 2008; 40:2750-4. [PMID: 18929853 DOI: 10.1016/j.transproceed.2008.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was performed to examine the antigenicity of formaldehyde-fixed arterial allografts and their potential clinical application for hemodialysis access. Human femoral arteries were fixed with formaldehyde. New Zealand white rabbits were immunized with antigens prepared from fixed or unfixed grafts followed by anti-serum collection. The antigenicity of fixed grafts was evaluated using double-diffusion in two dimensions. Seventy-six fixed allografts were transplanted into 50 patients with end-stage renal diseases as hemodialysis access and monitored for acute rejection, blood flow, and patency rates. Anti-HLA antibody was evaluated using a panel-reactive antibody (PRA) assay in 6 patients. Formaldehyde-fixed grafts demonstrated reduced antigenicity as determined using double-diffusion in two dimensions when compared with unfixed grafts. Histological evaluation of allografts demonstrated absence of cell-mediated acute rejection after transplantation. Allografts demonstrated satisfactory blood flow with primary and secondary patency rates at 1, 2, and 3 years after allotransplantation. Serum collected from 6 patients after transplantation (mean, 3.3 +/- 3.2 years) did not demonstrate increased anti-HLA antibody levels. The allograft intimal hyperplasia was characterized by proliferation of actin-expressing smooth muscle cells. This study demonstrated that formaldehyde fixation reduced the antigenicity of arterial allografts. Acute rejection was absent after allotransplantation. The lack of increased PRA levels after allotransplantation suggested that allo-sensitization is not induced by fixed allografts. The use of formaldehyde-fixed allografts as hemodialysis access demonstrated blood flow and patency rates. Intimal hyperplasia of allografts is characterized by proliferation of actin-expressing cells. Our results supported the clinical use of formaldehyde-fixed arterial allografts for hemodialysis access.
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Affiliation(s)
- Z Liu
- Department of Transplantation, Jinan City Central Hospital, Jinan, Shandong, P.R. China.
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23
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Liu Z, Zhu B, Wang X, Jing Y, Wang P, Wang S, Xu H. Clinical studies of hemodialysis access through formaldehyde-fixed arterial allografts. Kidney Int 2007; 72:1249-54. [PMID: 17687254 DOI: 10.1038/sj.ki.5002474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Efficient hemodialysis requires establishing a permanent stable vascular access. Our study was designed to evaluate formaldehyde-fixed arterial allografts as hemodialysis access for end-stage renal disease. Various parameters were determined for 68 formaldehyde-fixed, cadaver-derived allografts transplanted into 43 hemodialysis patients. The sources of the allografts were determined to be free of cytomegalovirus, hepatitis B and hepatitis C, and HIV infections. These allografts were monitored for rejection, blood flow, patency rates, and complications. Overall, antigenicity of the allografts was reduced after formaldehyde fixation with no acute rejection. The mean access blood flow was 696+/-282 ml with reasonable primary and secondary patency rates even after 3 years. Allograft intimal hyperplasia, determined by immunohistochemistry, was evident as the proliferation of smooth muscle-like cells expressing actin but cells not expressing the endothelial markers von Willebrand factor or CD34. The incidence of thrombus formation was about 37% after allograft transplant with other limited complications of pseudoaneurysms and local infection. Our results support the clinical use of formaldehyde-fixed arterial allografts for hemodialysis access.
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Affiliation(s)
- Z Liu
- Friendship Nephrology and Blood Purification Center, Jinan Central Hospital, Shandong University School of Medicine, Shandong, People's Republic of China.
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24
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Berardinelli L. Grafts and graft materials as vascular substitutes for haemodialysis access construction. Eur J Vasc Endovasc Surg 2006; 32:203-11. [PMID: 16490368 DOI: 10.1016/j.ejvs.2006.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 01/06/2006] [Indexed: 10/25/2022]
Abstract
Apart from long-term central venous catheterisation, the insertion of an arteriovenous graft (AVG) remains the only option to allow continued haemodialysis when the patient's superficial veins have been exhausted. Although, expanded PTFE has become the graft of choice for haemodialysis access throughout the world, many other organic or semi-organic materials are currently available for AVG construction. These are less prone to steal syndrome, easier to handle, more resistant to infection and may have similar, if not better, long term patencies.
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Affiliation(s)
- L Berardinelli
- Division of Vascular Surgery and Kidney Transplantation, Policlinico University Hospital Foundation, IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy.
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25
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Martin ND, Schaner PJ, Tulenko TN, Shapiro IM, Dimatteo CA, Williams TK, Hager ES, DiMuzio PJ. In Vivo Behavior of Decellularized Vein Allograft1,2. J Surg Res 2005; 129:17-23. [PMID: 16139306 DOI: 10.1016/j.jss.2005.06.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Revised: 06/13/2005] [Accepted: 06/14/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND We are investigating decellularized vein allograft as a scaffold to engineer a non-synthetic, small-diameter vascular graft. This study examines the in vivo behavior of this scaffolding after implantation into the arterial circulation. MATERIALS AND METHODS Canine animals underwent bilateral carotid interposition grafting using jugular vein implanted as either: 1) fresh autograft, 2) fresh allograft, or 3) decellularized allograft. Decellularization was achieved using sodium dodecyl sulfate. Grafts were examined with duplex ultrasound biweekly to determine luminal diameter, thrombosis, stenosis, or anastomotic breakdown. After perfusion fixation at 2 or 8 weeks, grafts underwent histological, morphometric, and immunohistochemical examination. RESULTS All animals survived without neurological or hemorrhagic complication. No deterioration of graft integrity (rupture, aneurysm) was observed in any group. Luminal narrowing was observed in both allograft groups, but secondary to different pathology. Fresh allografts had significant mononuclear cell infiltrate, intimal hyperplasia, and intramural hemorrhage consistent with rejection. Conversely, decellularized allografts had minimal evidence of rejection but instead had a compact fibrin layer formed along their lumen. This fibrin layer was absent in the peri-anastomotic regions where endothelium had migrated from the native artery. By 8 weeks, decellularized grafts had repopulated with cells staining positive for smooth muscle alpha-actin. CONCLUSIONS After 8 weeks of arterial flow, decellularized vein allograft exhibits satisfactory strength, reduced antigenicity compared to fresh allograft, and supports cellular repopulation. These characteristics make it satisfactory for further tissue engineering; combined with luminal vascular cell seeding, it may prove useful as a small-diameter arterial bypass graft.
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Affiliation(s)
- Niels D Martin
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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26
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Zehr KJ, Yagubyan M, Connolly HM, Nelson SM, Schaff HV. Aortic root replacement with a novel decellularized cryopreserved aortic homograft: Postoperative immunoreactivity and early results. J Thorac Cardiovasc Surg 2005; 130:1010-5. [PMID: 16214512 DOI: 10.1016/j.jtcvs.2005.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 02/25/2005] [Accepted: 03/23/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Novel antigen-reduction SynerGraft technology (CryoLife Inc, Kennesaw, Ga) reduces the cellular components of a cadaver homograft with an enzymatic and washing process, leaving the extracellular matrix intact. We report the immunoreactivity (positive panel reactive antibody assay) and early operative results of the CryoLife SynerGraft aortic valve conduit homograft. METHODS Twenty-two patients (age 53 +/- 14 years, range 31-80 years) from April 2002 to July 2003 underwent aortic root replacement with a CryoLife SynerGraft aortic valve conduit homograft (CryoLife Inc, Kennesaw, Ga) for congenital or acquired aortic valve disease, aortic aneurysm with aortic valve disease, or native or prosthetic aortic valve endocarditis. Baseline percentage positive panel reactive antibody results were negative (<10%) for all and were assessed at 1 month, 3 months, and 1-year. Homograft function was evaluated by echocardiography. RESULTS Early mortality was 0%. Two late deaths at 1 postoperative year were unrelated to homograft function. At 1 postoperative month, panel reactive antibody results were negative in 20 patients (91%). At 3 months, 19 of 22 patients (86%) had negative results, including 1 with previous positive results. At 1 year, 19 of 20 patients (95%) had negative results, including 2 of the 3 with previous positive results. The mean aortic valve gradients were 12 +/- 8 mm Hg (n = 21) at discharge and 11 +/- 7 mm Hg (n = 18) at 1 year. At a mean follow-up of 30.3 +/- 5.2 months, the mean gradient was 8.8 +/- 6.3 mm Hg. CONCLUSION The SynerGraft decellularization technology successfully removed antigens from an aortic valve homograft conduit. Aortic root reconstruction with the CryoLife SynerGraft aortic valve homograft resulted in low transvalvular gradients, similar to those seen with standard cryopreserved homografts. These early results suggest an advancement in homograft technology. The low panel reactive antibody response may enhance durability by eliminating immune complex-mediated reaction against the homograft. The lack of allosensitization in patients who may require organ transplantation in the future is an added benefit.
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Affiliation(s)
- Kenton J Zehr
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
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27
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Madden RL, Lipkowitz GS, Browne BJ, Kurbanov A. A Comparison of Cryopreserved Vein Allografts and Prosthetic Grafts for Hemodialysis Access. Ann Vasc Surg 2005; 19:686-91. [PMID: 16075346 DOI: 10.1007/s10016-005-6621-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In hemodialysis patients with insufficient vasculature for creation of a native arteriovenous fistula (AVF), a polytetrafluoroethylene (PTFE) graft is commonly utilized. Because of PTFE complications, our group and others have used cryopreserved cadaver femoral vein allografts (Synergraft [SYN], CryoLife, Marietta, GA) in selected patients. Based on our experience with these allografts, we hypothesized that they were more resistant to thrombosis than PTFE grafts. The purpose of this study was to compare the thrombosis rates of SYN and PTFE grafts in a prospective, randomized fashion. Our study was interrupted when the FDA ordered CryoLife, Inc. to retain certain vascular tissue products, and patient accrual stopped in 2003. Most patients referred for hemodialysis access are evaluated with bilateral, upper extremity Doppler ultrasound. Starting in 2001, those with insufficient vasculature for native AVF were offered randomization into the PTFE or SYN groups. All accesses were placed in the upper extremity, above the elbow. Access patency and complications were recorded, and failure was defined as access removal, abandonment, or replacement of > 50% with a new conduit. Prior to FDA interruption of the study, 27 patients were randomized into each group. Patient characteristics were similar, but there were significantly more males and African-Americans in the SYN group. No significant differences were seen in primary or secondary patency, number of thrombectomies, revisions, or total interventions. Significantly more fistulagrams were performed in the SYN group (p < 0.05). No infections were seen in either group, but 2 aneurysms occurred in the SYN group. Nine (33%) patients in each group died with functioning access. Access failures: In the SYN group, 8 of 27 (30%) failed, with 5 failing from multiple access stenoses unresponsive to balloon angioplasty; in the PTFE group 4 of 27 (18%) failed, with 2 failing from multiple stenoses. In conclusion, for initial hemodialysis access in patients without sufficient vasculature for native AVF, our results do not support the routine use of SYN allografts in the general dialysis population.
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Affiliation(s)
- Robert L Madden
- Transplant Division, Department of Surgery, Baystate Medical Center, Springfield, MA 01107, USA.
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28
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Madden RL, Lipkowitz GS, Browne BJ, Kurbanov A. Experience with cryopreserved cadaveric femoral vein allografts used for hemodialysis access. Ann Vasc Surg 2004; 18:453-8. [PMID: 15156363 DOI: 10.1007/s10016-004-0055-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study was to review the patency and complications of cryopreserved vein allografts used for hemodialysis access, and to compare them to a group with polytetrafluoroethylene (PTFE) grafts. Patients without adequate vasculature for native fistula were implanted with vein allografts or PTFE grafts at the surgeon's discretion. Only cryopreserved (CRY) veins were used until January 2001, when decellularized, cryopreserved Synergraft (SYN) veins became available. The CRY group had 48 patients; the SYN group, 42 patients; the PTFE group, 100 patients, who were selected from billing records listing PTFE graft insertion. Patient demographics were similar. Primary and secondary patencies were not significantly different at 1 or 2 years between groups. Complications in PTFE versus CRY and SYN groups were as follows: infection, 10 % vs. 0% (p < 0.01); aneurysm, 2% vs. 18% (p < 0.001); and steal syndrome, 12% vs. 12% (p = NS). Significantly more vein allograft patients lost their accesses to aneurysm (p < 0.01) and multiple stenoses (p < 0.05), whereas PTFE patients lost significantly more accesses to infection (p < 0.01) and recurrent thrombosis (p < 0.05). We conclude that cadaver vein allografts have similar patency to PTFE grafts. These allografts are more resistant to infection but significantly more susceptible to aneurysms. When used, vein allografts should be monitored aggressively for the development of aneurysms.
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Affiliation(s)
- Robert L Madden
- Department of Surgery, Transplant Division, Baystate Medical Center, Springfield, MA, USA.
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29
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Madden R, Lipkowitz G, Benedetto B, Kurbanov A, Miller M, Bow L. Decellularized cadaver vein allografts used for hemodialysis access do not cause allosensitization or preclude kidney transplantation. Am J Kidney Dis 2002; 40:1240-3. [PMID: 12460043 DOI: 10.1053/ajkd.2002.36892] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dimethyl sulfoxide-cryopreserved (CRY) cadaver vein allografts used for hemodialysis access in patients with renal failure recently have been shown to cause broad recipient allosensitization, measured by panel reactive antibody (PRA) assay. Synergraft (SYN) processing is a novel method of treating tissue that decellularizes the graft (including mismatched major histocompatibility antigens) and potentially should prevent allosensitization. METHODS Twenty hemodialysis patients underwent placement of an SYN-processed cadaver vein allograft. PRA assay was used prospectively to assess allosensitization in these patients at baseline and 1-month intervals after engraftment. These results were compared with our historic series of CRY allograft recipients. RESULTS There was no significant difference in baseline PRA values for SYN and CRY patients (2.8% versus 2.6%, respectively). None of the SYN patients became allosensitized at 3 months postengraftment (mean PRA, 3.2%), whereas all CRY recipients became highly sensitized at a mean of 3.1 months (mean PRA, 84.1%). This result was highly significant (P < 0.0001). CONCLUSION SYN processing of cadaver vein allografts successfully removes antigenic material. The use of SYN allografts in patients with renal failure for hemodialysis access does not cause allosensitization and therefore should not preclude kidney transplantation.
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Affiliation(s)
- Robert Madden
- Department of Surgery, Transplant Division, Baystate Medical Center, Tufts University, School of Medicine, Springfield, MA, USA.
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