Graft vasculopathy in upper extremity allotransplantation: Results of a retrospective high‐resolution ultrasonographic study

Abstract

Graft vasculopathy (GV) is the most severe pathologic change of chronic rejection in vascularized composite allotransplantation. Since 2012, the intimal media thickness (IMT) of radial and ulnar arteries was annually monitored by high‐resolution ultrasonography in seven bilateral upper extremity transplant (UET) patients. We also investigated the IMT of seven matched healthy subjects (controls). No significant difference between IMT values of controls and UET patients was found. The median IMT values of recipient radial and ulnar arteries were 0.23 mm and 0.25 mm, respectively, while the median IMT values of grafted radial and ulnar arteries were 0.27 mm and 0.30 mm, respectively. There was a statistically significant difference in the IMT values of the grafted and recipient ulnar arteries (p = .043), but this difference was no longer significant when patient #2 was excluded. He showed a significant difference between recipient and grafted arteries and significantly higher IMT values (p = .001) of his grafted arteries compared with those of all transplanted patients. This patient developed GV leading to graft loss 11 years after the transplantation. In conclusion, this study showed a significant IMT increase in an UET recipient who developed GV.

Defining chronic rejection in vascularized composite allografts – do we have reliable surrogates to look for?

“…It was suggested that the ratio of facial/radial artery IT could be used as a benchmark parameter for the diagnosis of CR [29]. Another high-resolution ultrasonographic study performed with the Philips iU22 device with probe L15-7io in three UEA recipients investigated the arterial intimal media thickness (IMT), defined as the distance between blood-intima and mediaadventitia interface; it revealed a significant IMT increase and detected a digital artery thrombosis in a recipient who developed CR due to GV and lost his allograft [30,31]. Flow magnetic resonance imaging was used in two FA recipients and showed a decrease of the flow and obliteration of facial arteries concomitant with the development of skin changes suggestive of CR [32,33].…”