Baraldi A, Manenti A, Di Felice A, Grosoli M, Furci L, Leonelli M, Manca V, Roncaglia R, Lusvarghi E
Department of Nephrology, University of Modena, Italy.
ASAIO Trans. 1989 Jul-Sep;35(3):196-9. doi: 10.1097/00002480-198907000-00006.
Since November 1987, a total of 16 dialysis patients in the authors' Center, received a cryopreserved saphenous vein allograft (CSVA) as "third choice" vascular access. ABO and HLA-A-B compatibilities were determined but not considered. Saphenous veins were cryopreserved in liquid nitrogen for variable periods (1-6 mo), so that there was the opportunity to choose the most suitable in dimension. In February, 1989, a total of 13 patients retained a well-functioning access site, whereas three had died from causes unrelated to CSVA. Because rejection of venous allografts still is debated among angiologists, recipient T lymphocyte subsets (CD3-CD4-CD8 and CD4/8) were examined, as were lymphocytotoxic antibodies, before and on days 15 and 30 after implantation. No evidence of immunologic activation was found. Moreover, in 10 of 16 patients the surgeons subcutaneously implanted a fragment of CSVA, and an immunohistochemical study was carried out using an alkaline phosphatase-antialkaline phosphatase (APAAP) technique and a panel of monoclonal antibodies. Minimal infiltration of the outer layer of adventitia was found, mainly caused by monocyte macrophages (Leu M3+) with few T lymphocytes (CD3+). The authors conclude that rejection is not a major cause of failure in CSVA in dialysis patients.
自1987年11月以来，作者所在中心共有16例透析患者接受了冷冻保存的大隐静脉同种异体移植（CSVA）作为“第三选择”的血管通路。确定了ABO血型和HLA - A - B相容性，但未予以考虑。大隐静脉在液氮中冷冻保存不同时间（1 - 6个月），以便有机会选择尺寸最合适的。1989年2月，共有13例患者的血管通路部位功能良好，而3例死于与CSVA无关的原因。由于血管外科医生对静脉同种异体移植的排斥反应仍存在争议，在植入前以及植入后第15天和第30天检测了受体T淋巴细胞亚群（CD3 - CD4 - CD8和CD4/8）以及淋巴细胞毒性抗体。未发现免疫激活的证据。此外，16例患者中有10例外科医生将CSVA的一段皮下植入，并使用碱性磷酸酶 - 抗碱性磷酸酶（APAAP）技术和一组单克隆抗体进行了免疫组织化学研究。发现外膜外层有轻微浸润，主要由单核巨噬细胞（Leu M3 +）引起，T淋巴细胞（CD3 +）较少。作者得出结论，排斥反应不是透析患者CSVA失败的主要原因。
