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01.05.2016 | ICS congress 2015 | Sonderheft 2/2016

European Surgery 2/2016

Cold-stored arterial allografts for in situ reconstruction of infected prosthetic grafts

Review of immunosuppressive protocols used in clinical practice

Zeitschrift:
European Surgery > Sonderheft 2/2016
Autoren:
Rudolf Spunda, Jan Hruby, Milos Adamec, Martin Varga, Jaroslav Lindner, Ivan Matia, Miroslav Spacek
Wichtige Hinweise
The supplement is dedicated to Jubilee World congress of International College of Surgeons 2015.
The publishing was sponsored by the Ministry of Health of the Czech Republic.
I. Matia and M. Spacek share senior authorship and have contributed equally to this work.

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.

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