Vascularized Thymosternal Composite Tissue Allo- and Xenotransplantation in Nonhuman Primates: Initial Experience

Selin Sendil, MD; Silviu C. Diaconu, MD; Natalie A. O’Neill, MD; Lars Burdorf, MD; Ivan Tatarov, DVM; Dawn M. Parsell, BS; Agnes M. Azimzadeh, PhD; Richard N. Pierson, III, MD; Arthur J. Nam, MD

doi:10.1097/GOX.0000000000001538

Plastic and Reconstructive Surgery, Global Open (Dec 2017)

Vascularized Thymosternal Composite Tissue Allo- and Xenotransplantation in Nonhuman Primates: Initial Experience

Selin Sendil, MD,
Silviu C. Diaconu, MD,
Natalie A. O’Neill, MD,
Lars Burdorf, MD,
Ivan Tatarov, DVM,
Dawn M. Parsell, BS,
Agnes M. Azimzadeh, PhD,
Richard N. Pierson, III, MD,
Arthur J. Nam, MD

Affiliations

Selin Sendil, MD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Silviu C. Diaconu, MD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Natalie A. O’Neill, MD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Lars Burdorf, MD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Ivan Tatarov, DVM: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Dawn M. Parsell, BS: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Agnes M. Azimzadeh, PhD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Richard N. Pierson, III, MD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.
Arthur J. Nam, MD: From the *Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.; †Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Md.

DOI: https://doi.org/10.1097/GOX.0000000000001538
Journal volume & issue: Vol. 5, no. 12
p. e1538

Abstract

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Background:. Vascularized composite allotransplantation is constrained by complications associated with standard immunosuppressive strategies. Vascularized thymus and bone marrow have been shown to promote prolonged graft survival in composite organ and soft-tissue vascularized composite allotransplantation models. We report development of a nonhuman primate vascularized thymosternal composite tissue transplant model as a platform to address donor-specific immune tolerance induction strategies. Methods:. Vascularized thymosternal allograft (skin, muscle, thymus, sternal bone) was transplanted between MHC-mismatched rhesus monkeys (feasibility studies) and baboons (long-term survival studies), with end-to-side anastomoses of the donor aorta and SVC to the recipient common femoral vessels. A male allograft was transplanted to a female’s lower abdominal wall, and clinically applicable immunosuppression was given. Skin biopsies and immunological assays were completed at regular intervals, and chimerism was quantified using polymerase chain reaction specific for baboon Y chromosome. Results:. Four allo- and 2 xenotransplants were performed, demonstrating consistent technical feasibility. In 1 baboon thymosternal allograft recipient treated with anti-CD40–based immunosuppression, loss of peripheral blood microchimerism after day 5 was observed and anticipated graft rejection at 13 days. In the second allograft, when cutaneous erythema and ecchymosis with allograft swelling was treated with anti-thymocyte globulin starting on day 6, microchimerism persisted until immunosuppression was reduced after the first month, and the allograft survived to 87 days, 1 month after cessation of immunosuppression treatment. Conclusions:. We established both allo- and xeno- composite vascularized thymosternal transplant preclinical models, which will be useful to investigate the role of primarily vascularized donor bone marrow and thymus.

Published in Plastic and Reconstructive Surgery, Global Open

ISSN: 2169-7574 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://www.prsgo.com

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