Jeffrey P. Carpenter, MD, John E. Tomaszewski, MD

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Presentation transcript:

Immunosuppression for human saphenous vein allograft bypass surgery: A prospective randomized trial Jeffrey P. Carpenter, MD, John E. Tomaszewski, MD Journal of Vascular Surgery Volume 26, Issue 1, Pages 32-42 (July 1997) DOI: 10.1016/S0741-5214(97)70144-7 Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Life-table analysis of primary graft patency data of immunosuppressed (n = 17) and control (n = 23) patients who received saphenous vein allograft bypass grafts. No significant difference between the immunosuppressed and control groups was identified for primary graft patency. Error bars represent the standard error. Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Life-table analysis of limb salvage data for immunosuppressed (n = 17) and control (n = 23) patients who received saphenous vein allograft bypass grafts. No significant difference was found between immunosuppressed and control groups for limb salvage rate. Error bars represent the standard error. Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Development of anti-HLA antibodies after vein allograft bypass grafting in 38 patients. The development of anti-HLA antibodies for individual patients after the bypass procedures suggests a humoral immune response to the allograft and implies the antigenicity of the bypass graft. Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Comparison of primary graft patency in patients with anti-HLA antibodies (positive) vs. patients without anti-HLA antibodies (negative) detected before surgery. The presence of preoperative anti-HLA antibodies significantly predicted bypass graft failure at the 90% but not the 95% significance level. Error bars represent the standard error. Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Biopsy at the time of implantation of a saphenous vein allograft shows apoptosis of the outer layers of the smooth muscle. This is thought to be a preservation/procurement–related phenomenon. Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Human saphenous vein allograft rejection demonstrated in an explanted vein allograft. The inflammatory infiltrate (A) is demonstrated to be predominantly T-lymphocytes on this photomicrograph using a CD3 marker (B). Macrophages (C) and B-lymphocytes (D) are less prevalent (CD68 and L26 markers, respectively). Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Human saphenous vein allograft rejection demonstrated in an explanted vein allograft. The inflammatory infiltrate (A) is demonstrated to be predominantly T-lymphocytes on this photomicrograph using a CD3 marker (B). Macrophages (C) and B-lymphocytes (D) are less prevalent (CD68 and L26 markers, respectively). Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Human saphenous vein allograft rejection demonstrated in an explanted vein allograft. The inflammatory infiltrate (A) is demonstrated to be predominantly T-lymphocytes on this photomicrograph using a CD3 marker (B). Macrophages (C) and B-lymphocytes (D) are less prevalent (CD68 and L26 markers, respectively). Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Human saphenous vein allograft rejection demonstrated in an explanted vein allograft. The inflammatory infiltrate (A) is demonstrated to be predominantly T-lymphocytes on this photomicrograph using a CD3 marker (B). Macrophages (C) and B-lymphocytes (D) are less prevalent (CD68 and L26 markers, respectively). Journal of Vascular Surgery 1997 26, 32-42DOI: (10.1016/S0741-5214(97)70144-7) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions