Wystrychowski Wojciech, Cierpka Lech, Zagalski Krzysztof, Garrido Sergio, Dusserre Nathalie, Radochonski Sam, McAllister Todd N, L'heureux Nicolas
Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
J Vasc Access. 2011 Jan-Mar;12(1):67-70. doi: 10.5301/jva.2011.6360.
Previously we reported on the mid- to long-term follow-up in the first clinical trial to use a completely autologous tissue-engineered graft in the high pressure circulation. In these early studies, living grafts were built from autologous fibroblasts and endothelial cells obtained from small skin and vein biopsies. The graft was assembled using a technique called tissue-engineering by self-assembly (TESA), where robust conduits were grown without support from exogenous biomaterials or synthetic scaffolding. One limitation with this earlier work was the long lead times required to build the completely autologous vascular graft. Here we report the first implant of a frozen, devitalized, completely autologous Lifeline™ vascular graft. In a departure from previous studies, the entire fibroblast layer, which provides the mechanical backbone of the graft, was air-dried then stored at -80°C until shortly before implant. Five days prior to implant, the devitalized conduit was rehydrated, and its lumen was seeded with living autologous endothelial cells to provide an antithrombogenic lining. The graft was implanted as an arteriovenous shunt between the brachial artery and the axillary vein in a patient who was dependent upon a semipermanent dialysis catheter placed in the femoral vein. Eight weeks postoperatively, the graft functions without complication. This strategy of preemptive skin and vein biopsy and cold-preserving autologous tissue allows the immediate availability of an autologous arteriovenous fistula, and is an important step forward in our strategy to provide allogeneic tissue-engineered grafts available "off-the-shelf".
此前，我们报道了首例在高压循环中使用完全自体组织工程移植物的临床试验的中长期随访情况。在这些早期研究中，活性移植物由取自小块皮肤和静脉活检组织的自体成纤维细胞和内皮细胞构建而成。该移植物采用一种称为自组装组织工程（TESA）的技术进行组装，在没有外源性生物材料或合成支架支持的情况下生长出坚固的管道。这项早期工作的一个局限性是构建完全自体血管移植物所需的准备时间较长。在此，我们报告首例植入冷冻、失活的完全自体生命线™血管移植物的情况。与先前的研究不同，提供移植物机械支撑的整个成纤维细胞层经风干后在-80°C下保存，直至植入前不久。植入前5天，将失活的管道复水，并在其管腔内接种活性自体内皮细胞以提供抗血栓内膜。在一名依赖置于股静脉的半永久性透析导管的患者中，将该移植物作为肱动脉与腋静脉之间的动静脉分流器进行植入。术后8周，移植物功能正常，无并发症。这种预先进行皮肤和静脉活检并冷藏自体组织的策略可立即获得自体动静脉内瘘，是我们提供“现货供应”的同种异体组织工程移植物策略向前迈出的重要一步。
