Cold-stored arterial allografts for in situ reconstruction of infected prosthetic grafts. Review of immunosuppressive protocols used in clinical practice
Abstract
Introduction: Strong antigenicity of arterial allografts triggering immune response similar to rejection processes evident in solid organ transplant recipients was observed in animal experiments. A higher incidence of graft-related death, graft ruptures or thrombosis and graft aneurysm formation was observed in non-immunosuppressed patients after arterial implantation.
Methodology: The use of immunosuppression is not generally accepted by vascular surgeons. In the cases in which immunosuppressive therapy is administered, the drug most frequently used is cyclosporine A (CyA).
This therapy has shown good mid-term results with no signs of recurrent infection. New immunosuppressive protocols with tacrolimus or sirolimus were published recently.
These drugs are routinely used in solid organ transplant patients and show some advantages, compared to cyclosporine A, with respect to hypertension, dyslipidaemia, and renal function. Results: The authors present available clinical immunosuppressive protocols in this indication and the results.
Moreover, our group has published good experimental and clinical results with immunosuppressive protocol featuring the delayed use of tacrolimus after transplantation of cold-stored arterial allograft. Conclusion: All this long-term experience with immunosuppression suggests the hypothesis that this therapy has a place in the armamentarium of the vascular surgeon performing arterial allograft implantations.