Multilevel Analysis of the Neovascularization and Integration Process of a Nonvascularized Rectus Fascia Transplantation

Ewout Muylle, BSc; Arne Maes, MSc; Gert De Hertogh, MD, PhD; Nele Van De Winkel, MD; Greet Kerckhofs, PhD; Antoine Dubois, MD; Vincent Vandecaveye, MD, PhD; Lieven Thorrez, PhD; Ina Hennion, MSc; Marie-Paule Emonds, MD, PhD; Steven Pans, MD; Nathalie P. Deferm, MD; Diethard Monbaliu, MD, PhD; Emilio Canovai, MD, PhD; Tim Vanuytsel, MD, PhD; Jacques Pirenne, MD, PhD; Laurens J. Ceulemans, MD, PhD

doi:10.1097/TXD.0000000000001624

Transplantation Direct (Jun 2024)

Multilevel Analysis of the Neovascularization and Integration Process of a Nonvascularized Rectus Fascia Transplantation

Ewout Muylle, BSc,
Arne Maes, MSc,
Gert De Hertogh, MD, PhD,
Nele Van De Winkel, MD,
Greet Kerckhofs, PhD,
Antoine Dubois, MD,
Vincent Vandecaveye, MD, PhD,
Lieven Thorrez, PhD,
Ina Hennion, MSc,
Marie-Paule Emonds, MD, PhD,
Steven Pans, MD,
Nathalie P. Deferm, MD,
Diethard Monbaliu, MD, PhD,
Emilio Canovai, MD, PhD,
Tim Vanuytsel, MD, PhD,
Jacques Pirenne, MD, PhD,
Laurens J. Ceulemans, MD, PhD

Affiliations

Ewout Muylle, BSc: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Arne Maes, MSc: 4 Department of Materials Engineering, KU Leuven, Leuven, Belgium.
Gert De Hertogh, MD, PhD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Nele Van De Winkel, MD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Greet Kerckhofs, PhD: 4 Department of Materials Engineering, KU Leuven, Leuven, Belgium.
Antoine Dubois, MD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Vincent Vandecaveye, MD, PhD: 13 Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Lieven Thorrez, PhD: 15 Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, KULAK campus Kortrijk, Kortrijk, Belgium.
Ina Hennion, MSc: 15 Tissue Engineering Lab, Department of Development and Regeneration, KU Leuven, KULAK campus Kortrijk, Kortrijk, Belgium.
Marie-Paule Emonds, MD, PhD: 16 Histocompatibility and Immunogenetics Laboratory, Belgian Red Cross-Flanders, Mechelen, Belgium.
Steven Pans, MD: 17 Department of Abdominal Surgery, Sint-Franciscusziekenhuis, Heusden-Zolder, Belgium.
Nathalie P. Deferm, MD: 17 Department of Abdominal Surgery, Sint-Franciscusziekenhuis, Heusden-Zolder, Belgium.
Diethard Monbaliu, MD, PhD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Emilio Canovai, MD, PhD: 18 Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Tim Vanuytsel, MD, PhD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Jacques Pirenne, MD, PhD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.
Laurens J. Ceulemans, MD, PhD: 1 Leuven Intestinal Failure and Transplantation (LIFT) Center, University Hospitals Leuven, Leuven, Belgium.

DOI: https://doi.org/10.1097/TXD.0000000000001624
Journal volume & issue: Vol. 10, no. 6
p. e1624

Abstract

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Background. Failure to close the abdominal wall after intestinal transplantation (ITx) or multivisceral Tx remains a surgical challenge. An attractive method is the use of nonvascularized rectus fascia (NVRF) in which both layers of the donor abdominal rectus fascia are used as an inlay patch without vascular anastomosis. How this graft integrates over time remains unknown. The study aims to provide a multilevel analysis of the neovascularization and integration process of the NVRF. Methods. Three NVRF-Tx were performed after ITx. Clinical, radiological, histological, and immunological data were analyzed to get insights into the neovascularization and integration process of the NVRF. Moreover, cryogenic contrast-enhanced microfocus computed tomography (microCT) analysis was used for detailed reconstruction of the vasculature in and around the NVRF (3-dimensional histology). Results. Two men (31- and 51-y-old) and 1 woman (49-y-old) underwent 2 multivisceral Tx and 1 combined liver-ITx, respectively. A CT scan showed contrast enhancement around the fascia graft at 5 days post-Tx. At 6 weeks, newly formed blood vessels were visualized around the graft with Doppler ultrasound. Biopsies at 2 weeks post-Tx revealed inflammation around the NVRF and early fibrosis. At 6 months, classical 2-dimensional histological analysis of a biopsy confirmed integration of the fascia graft with strong fibrotic reaction without signs of rejection. A cryogenic contrast-enhanced microCT scan of the same biopsy revealed the presence of microvasculature, enveloping and penetrating the donor fascia. Conclusions. We showed clinical, histological, and microCT evidence of the neovascularization and integration process of the NVRF after Tx.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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