Den Hondt Margot, Vanaudenaerde Bart M, Verbeken Erik K, Vranckx Jan J
a Department of Plastic & Reconstructive Surgery , University Hospitals Leuven , Leuven , Belgium.
b Lung Transplant Unit, Laboratory of Pulmonology, Department of Clinical and Experimental Medicine , KU Leuven - University of Leuven , Leuven , Belgium.
Acta Chir Belg. 2016 Jun;116(3):164-174. doi: 10.1080/00015458.2016.1210844. Epub 2016 Oct 4.
Successful trachea transplantation comprises the use of biocompatible constructs with little immune-reactivity, submucosal revascularization and creation of an epithelial covering. Allogenic chondrocytes might be protected from an overt immune-response due to physical isolation. Our aim was to evaluate in-vivo biocompatibility of allotracheae, stripped of their highly-immunogenic inner lining. Secondly, we established whether these constructs might serve as suitable scaffolds for autologous epithelial grafting.
Mucosa and submucosa of 12 rabbit donor tracheae were mechanically peeled off. Cartilage was covered with Integra™ regeneration-template. Constructs were implanted within the recipient's lateral thoracic artery flap. Integra of 6 revascularized allotracheae was grafted with autologous buccal mucosa. Macroscopical, histological analysis and immunohistochemistry were performed.
Revascularization and buccal grafting was incomplete in the first 2 circular constructs. To enhance blood-vessel outgrowth, the following 10 transplants were opened longitudinally before implantation. Integra revascularized well. Grafted tracheae showed satisfactory mucosa-adherence, albeit with invasion of migrating epithelium within the Integra-scaffold.
Mechanically-stripped allotracheae exhibited beneficial biocompatibility up to two months. This approach might open doors in the treatment of long-segment tracheal pathologies of which immunosuppression is contra-indicated. Thickness of this layered construct limited practical feasibility of orthotopic transfer, though with further refinements, a clinically-useful transplant could be created.
成功的气管移植包括使用具有低免疫反应性的生物相容性构建体、黏膜下血管再生以及形成上皮覆盖层。由于物理隔离，同种异体软骨细胞可能免受明显的免疫反应。我们的目的是评估去除高度免疫原性内衬的同种异体气管的体内生物相容性。其次，我们确定这些构建体是否可作为自体上皮移植的合适支架。
机械剥离12只兔供体气管的黏膜和黏膜下层。用Integra™ 再生模板覆盖软骨。将构建体植入受体的侧胸动脉皮瓣内。对6个血管化的同种异体气管的Integra移植自体颊黏膜。进行宏观、组织学分析和免疫组织化学检查。
前2个环形构建体的血管再生和颊黏膜移植不完全。为促进血管生长，接下来的10个移植体在植入前纵向切开。Integra血管再生良好。移植的气管显示出令人满意的黏膜黏附，尽管有迁移的上皮细胞侵入Integra支架内。
机械剥离的同种异体气管在长达两个月的时间内表现出良好的生物相容性。这种方法可能为治疗禁忌免疫抑制的长段气管病变打开大门。这种分层构建体的厚度限制了原位移植的实际可行性，不过通过进一步改进，可以制造出临床上有用的移植体。
