Decellularized cadaver vein allografts used for hemodialysis access do not cause allosensitization or preclude kidney transplantation.
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).


CONCLUSIONS
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.
Madden
Robert
R
Department of Surgery, Transplant Division, Baystate Medical Center, Tufts University, School of Medicine, Springfield, MA, USA. madorac@excell.net
Lipkowitz
George
G
Benedetto
Bernard
B
Kurbanov
Alexander
A
Miller
Maureen
M
Bow
Laurine
L
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D001808:Blood Vessels / Q000276:immunology* / Q000637:transplantation*; D002102:Cadaver; D000075202:Contraindications; D005260:Female; D006085:Graft Survival; D006801:Humans; D007114:Immunization; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods