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Ann Thorac Surg 1995;60:S122-S126
© 1995 The Society of Thoracic Surgeons


Articles

Immunologic reaction and viability of cryopreserved homografts

MD Teddy Fischlein*, MD Albert Schütz, MD Markus Haushofer, BS Rainer Frey, Antje Uhlig, MD Christian Detter, MD Bruno Reichart

Department of Cardiac Surgery, University of Munich—Grosshadern Medical Center, Munich, Germany

* Address reprint requests to Dr Fischlein, Department of Cardiac Surgery, University of Munich—Grosshadern Medical Center, Marchioninistr 15, 81377 Munich, Germany.


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Homograft cell viability after cryopreservation was investigated and cytoimmunologic monitoring was performed during the early postoperative course to research possible immunologic reactions after allograft aortic valve replacement. After cryopreservation, morphologic observations were made, a nonradioactive cell proliferation assay was used, and prostaglandin I2 secretion of the remaining endothelial cells was determined. Cytoimmunologic monitoring was performed daily within the first 3 weeks postoperatively. An increase of the activation index greater than 1 was rated as an immunologic reaction. Maintained metabolic activity of graft endothelial cells after cryopreservation was confirmed by prostaglandin I2 release (9.24 ± 3.48 ng/cm2 basic release and 20.1 ± 5.76 ng/cm2 when stimulated with 25 µmol/L N a arachidonic acid). Cell proliferation was indicated after graft incubation with the nonradioactive viability kit (0.27 ± 0.9 at 450 nm). Cytoimmunologic examinations (n = 861) after homograft implantation showed a more intense activation in patients with ABO-incompatible grafts (activation index 2.1 ± 1.6, n = 16) than in those with ABO-compatible grafts (activation index 1.3 ± 0.8, n = 17). In these groups, the duration of activation by cytoimmunologic monitoring was 2.8 ± 1.5 days and 1.3 ±0.6 days, respectively (p < 0.041). No activation was observed in 8 patients after xenograft valve replacement (p < 0.01). Our data indicate that cryopreservation of homograft valves represents a cell- and tissue-protective preservation method. Postoperatively, all homograft valves caused immunologic reactions, which were reversible without immunosuppression treatment.


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** Presented at the VI International Symposium for Cardiac Bioprostheses, Vancouver, BC, Canada, July 29–31, 1994.


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  1. (Suppl)O'Brien MF, McGiffin DC, Stafford EG, et al. Allograft aortic valve replacement: long-term comparative clinical analysis of the viable cryopreserved and antibiotic 4°C stored valves J Cardiac Surg 1991;6:534-543.[Medline]
  2. Zhao X, Green M, Frazer IH, Hogan P, O'Brien MF. Donorspecific immune response after aortic valve allografting in the rat Ann Thorac Surg 1994;57:1158-1163.[Abstract/Free Full Text]
  3. Cochran RP, Kunzelman KS. Cryopreservation does not alter antigenic expression of aortic allografts J Surg Res 1989;46:597-599.[Medline]
  4. Yankah AC, Wottge HU, Miiller-Ruchholtz W. Antigenicity and fate of cellular components of heart valve allograftsIn: Yankah AC, Hetzer R, Yacoub MH, editors. Cardiac valve allografts 1962–1987. Current concepts on the use of aortic and pulmonary allografts for heart valve substitutes. Darmstadt: Steinkopff Verlag; 1988. pp. 77-78.
  5. Hammer C, Reichenspurner H, Ertel W, et al. Cytological and immunological monitoring of cyclosporin-treated human heart recipients J Heart Transplant 1984;3:228-231.
  6. Ross DN. Technique of aortic valve replacement with a homograft: orthotopic replacement Ann Thorac Surg 1991;52:154-156.[Abstract/Free Full Text]
  7. Mulligan MS, Tsai TT, Kneebone JM, Ward PA, Lupinetti FM. Effects of preservation techniques on in vivo expression of adhesion molecules by aortic valve allografts J Thorac Cardiovasc Surg 1994;107:717-723.[Abstract/Free Full Text]
  8. Daly RC, Orszulak TA, Schaff HV, McGovern E, Wallace RB. Long-term results of aortic valve replacement with nonviable homografts Circulation 1991;84(Suppl 3):81-88.
  9. Barratt-Boyes BG, Roche MB, Subramanyan R, Pemberton JR, Whitlock RM. Long-term follow-up of patients with the antibiotic-sterilized aortic homograft valve inserted freehand in the aortic position Circulation 1987;75:768-777.[Abstract/Free Full Text]
  10. O'Brien MF, Stafford EG, Gardner MA, Pohlner PG, McGiffin DC. A comparison of aortic valve replacement with viable cryopreserved and fresh allograft valves, with a note on chromosomal studies J Thorac Cardiovasc Surg 1987;94:812-823.[Abstract]
  11. Hammer C. Cytology in transplantationPercha, Germany: Schulz-Verlag; 1989.



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