title: Long-term composite tissue allograft survival in a porcine model with cyclosporine/mycophenolate mofetil therapy.
abstract: BACKGROUND
  Low-dose cyclosporine (CsA)/mycophenolate mofetil (MMF) therapy has significantly reduced the frequency of rejection and drug-induced side effects in rat hindlimb allograft recipients. With an eye toward direct clinical application, we developed a large-animal extremity composite tissue allograft model to assess the antirejection efficacy and systemic toxicity of combination CsA/MMF treatment.
  
  
  METHODS
  Radial forelimb osteomyocutaneous flap transplants were performed between size-matched, outbred pigs assigned to one of two groups: 5 control pigs received no immunosuppression, and 10 pigs received a once-daily oral CsA/MMF/prednisone regimen. Rejection was assessed by visual inspection of flap skin and correlated with serial histopathologic examination of skin biopsies.
  
  
  RESULTS
  In all control pigs, the flap was completely rejected on day 7. Of the 10 pigs receiving treatment, one died from pneumonia and an another from an anesthetic complication on days 19 and 30, respectively, without signs of rejection. Two flaps were lost on days 25 and 29 from severe rejection. Three pigs were free of rejection at the end of the 90-day follow-up period, and three had stable mild-to-moderate rejection at 90 days (P= 0.0007 vs. controls). White blood cell and platelet counts, serum creatinine values, and liver function tests remained normal in all animals receiving immunosuppressive therapy.
  
  
  CONCLUSIONS
  Our results, to our knowledge, demonstrate for the first time that rejection can be significantly delayed in a large-animal composite tissue allograft model including skin using only orally administered agents dosed according to clinically relevant strategies without significant drug-specific systemic side effects.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
authors.forename: E T
authors.initials: ET
authors.lastname: Ustüner
authors.forename: M
authors.initials: M
authors.lastname: Zdichavsky
authors.forename: X
authors.initials: X
authors.lastname: Ren
authors.forename: J
authors.initials: J
authors.lastname: Edelstein
authors.forename: C
authors.initials: C
authors.lastname: Maldonado
authors.forename: M
authors.initials: M
authors.lastname: Ray
authors.forename: A W
authors.initials: AW
authors.lastname: Jevans
authors.forename: W C
authors.initials: WC
authors.lastname: Breidenbach
authors.forename: S A
authors.initials: SA
authors.lastname: Gruber
authors.forename: J H
authors.initials: JH
authors.lastname: Barker
authors.forename: J W
authors.initials: JW
authors.lastname: Jones
mesh_terms: D000818:Animals; D016572:Cyclosporine / Q000627:therapeutic use*; D005552:Forelimb; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012867:Skin / Q000473:pathology; D013524:Surgical Flaps; D013552:Swine; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid