Skip Navigation LinksHome > May 2013 - Volume 131 - Issue 5 > Functional Outcomes following Multiple Acute Rejections in E...
Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e3182879e85
Experimental: Original Articles

Functional Outcomes following Multiple Acute Rejections in Experimental Vascularized Composite Allotransplantation

Unadkat, Jignesh V. M.D.; Bourbeau, Dennis Ph.D.; Afrooz, Paul N. M.D.; Solari, Mario G. M.D.; Washington, Kia M. M.D.; Pulikkottil, Benson J. M.D.; Weber, Douglas J. Ph.D.; Lee, W. P. Andrew M.D.

Supplemental Author Material
Collapse Box

Abstract

Background: Vascularized composite allotransplantation has become a clinical reality. Patients undergoing vascularized composite allotransplantation have modest functional return. Most patients have had multiple acute rejections. The effect of multiple acute rejections influencing functional outcomes is unknown. This study systematically analyzes the effects of multiple acute rejections on functional outcome.

Methods: Rat functional orthotopic hind-limb transplants were performed from Brown-Norway to Lewis rats. Group 1 consisted of isografts. In group 2, daily cyclosporine was administered to prevent acute rejection. In group 3, recipients did not receive regular immunosuppression but received only pulsed cyclosporine and dexamethasone to rescue acute rejection. The study endpoint was 90 days. Muscle and sciatic nerve biopsy specimens were taken for histologic analyses. Hind-limb function was assessed using sciatic nerve axon density, nerve conduction velocity, and muscle force generated by the gastrocnemius muscle. Novel video kinematics was used to analyze gait.

Results: By the endpoint, group 3 animals had 17 ± 5.1 acute rejections. Muscle biopsy showed significant atrophy and fibrosis in group 3 compared with groups 1 and 2. Withdrawal to pin prick was evident by days 31 ± 1.2, 30 ± 2.3, and 31 ± 3.7 in groups 1, 2, and 3, respectively. At the endpoint, there was no significant difference in the axon density or nerve conduction velocity among the three groups, but muscle force generated was significantly less in group 3. Gait was abnormal in group 3 animals compared with other groups.

Conclusions: In this study, multiple acute rejections induced muscle atrophy and fibrosis and consequent decreased function. This emphasizes the importance of preventing acute rejection to achieve optimum function following vascularized composite allotransplantation.

©2013American Society of Plastic Surgeons

Login

Article Tools

Share


The Clinical Masters of PRS – Breast eBooks
4 Essential eBooks for Plastic Surgeons