Taoyuan, Taiwan; and Heidelberg, Germany From the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, and the Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg.
Plast Reconstr Surg. 2012 Jul;130(1):64-72. doi: 10.1097/PRS.0b013e3182547de1.
Composite tissue allotransplantation holds promise in reconstructive surgery, but its application is limited by the need for long-term immunosuppression. The objective of this study was to investigate the feasibility of low-dose cyclosporine and vascularized bone allotransplantation in prolonging the survival of vascularized adipose tissue allograft.
In the adipose tissue allograft model, adipose tissue allografts based on superficial epigastric vessels from Lewis-Brown-Norway rats were allotransplanted into Lewis rats. In the adipose tissue and bone marrow allograft model, combined vascularized bone marrow and adipose tissues were allografted from Brown Norway rats into Lewis rats. The graft survival, the onset and progression of rejection, and the effects of cyclosporine at different dosages and treatment durations were recorded. A rejection grading system was created based on gross observation and was correlated with histologic examinations.
Even at a low dose of 2 mg/kg/day, cyclosporine continued to provide effective allograft protection. Tolerance was not observed in either model. Adipose tissue survival after discontinuation of cyclosporine was independent of treatment duration. The inclusion of vascularized bone to the adipose tissue allograft provided an additional protective effect. This effect was synergistic with concomitant use of immunosuppressant.
Adipose tissue allotransplantation is a potential reconstructive option that requires only minimal use of immunosuppressants. Its survival can be further prolonged with simultaneous bone marrow allotransplantation.
复合组织同种异体移植在重建外科中具有广阔的应用前景，但由于需要长期免疫抑制，其应用受到限制。本研究旨在探讨低剂量环孢素和带血管骨同种异体移植延长血管化脂肪组织同种异体移植物存活的可行性。
在脂肪组织同种异体移植模型中，Lewis-Brown-Norway 大鼠腹壁浅动静脉来源的脂肪组织同种异体移植到 Lewis 大鼠体内。在脂肪组织和骨髓同种异体移植模型中，Brown Norway 大鼠的带血管骨髓和脂肪组织被同种异体移植到 Lewis 大鼠体内。记录移植物的存活、排斥的发生和进展以及不同剂量和治疗持续时间的环孢素的作用。根据大体观察建立了一种排斥分级系统，并与组织学检查相关联。
即使环孢素的剂量低至 2mg/kg/天，仍能持续提供有效的同种异体移植物保护。在两种模型中均未观察到耐受。停止使用环孢素后脂肪组织的存活与治疗持续时间无关。将带血管的骨与脂肪组织同种异体移植相结合可提供额外的保护作用。这种作用与免疫抑制剂的同时使用具有协同作用。
脂肪组织同种异体移植是一种潜在的重建选择，仅需最低限度使用免疫抑制剂。同时进行骨髓同种异体移植可进一步延长其存活时间。
