Absence of rejection in cryopreserved saphenous vein allografts for hemodialysis.
Since November 1987, a total of 16 dialysis patients in the authors' Center, received a cryopreserved saphenous vein allograft (CSVA) as "third choice" vascular access. ABO and HLA-A-B compatibilities were determined but not considered. Saphenous veins were cryopreserved in liquid nitrogen for variable periods (1-6 mo), so that there was the opportunity to choose the most suitable in dimension. In February, 1989, a total of 13 patients retained a well-functioning access site, whereas three had died from causes unrelated to CSVA. Because rejection of venous allografts still is debated among angiologists, recipient T lymphocyte subsets (CD3-CD4-CD8 and CD4/8) were examined, as were lymphocytotoxic antibodies, before and on days 15 and 30 after implantation. No evidence of immunologic activation was found. Moreover, in 10 of 16 patients the surgeons subcutaneously implanted a fragment of CSVA, and an immunohistochemical study was carried out using an alkaline phosphatase-antialkaline phosphatase (APAAP) technique and a panel of monoclonal antibodies. Minimal infiltration of the outer layer of adventitia was found, mainly caused by monocyte macrophages (Leu M3+) with few T lymphocytes (CD3+). The authors conclude that rejection is not a major cause of failure in CSVA in dialysis patients.