BACKGROUND: Allografts from cadaveric sources may be an alternative for replacing the missing auricle. In this report, the technical aspects of orthotopic composite auricle allotransplantation and an effective short-term immunosuppression protocol in a rat model are described. METHODS: A total of seven transplantations were performed in the experimental group. The donors were Brown Norway (RT1(n)) rats and the recipients were Lewis (RT1(1)) rats. In the pilot study, 11 isotransplantations (Lewis to Lewis) were performed in either heterotopic (n = 4) or orthotopic (n = 7) locations to establish the surgical technique. Composite auricle allografts were harvested and transplanted based on the posterior facial vein, the external carotid artery, and the great auricular nerve. A plastic square mold sutured over the transplants was used to prevent mechanical trauma to the transplants. Cyclosporine A initiated as 16 mg/kg/day for 2 weeks and tapered to a dosage of 8 mg/kg/day for another 2 weeks was the only immunosuppression regimen. RESULTS: All allografts survived with perfect viability for the follow-up period of 30 days. There were no signs of rejection, infection, or graft-versus-host disease, although significant weight loss was observed resulting from the immunosuppressive treatment. However, signs of rejection started 4 to 6 days after cessation of the cyclosporine A treatment, including edema, localized epidermal desquamation, and erythema formation that eventually progressed to necrosis within 11 to 14 days. The histologic outcomes were well correlated with the macroscopic appearance. CONCLUSIONS: It is feasible to elevate and transplant the composite auricle in rats as a single neurosensorial facial subunit. A tapered dose of cyclosporine A from 16 mg/kg to 8 mg/kg allows maintaining allograft survival for 30 days across a strong major histocompatibility complex barrier. This model is reliable and reproducible and has the potential to be used for future immunologic studies to prevent or to induce transplantation tolerance.
BACKGROUND: Allografts from cadaveric sources may be an alternative for replacing the missing auricle. In this report, the technical aspects of orthotopic composite auricle allotransplantation and an effective short-term immunosuppression protocol in a rat model are described. METHODS: A total of seven transplantations were performed in the experimental group. The donors were Brown Norway (RT1(n)) rats and the recipients were Lewis (RT1(1)) rats. In the pilot study, 11 isotransplantations (Lewis to Lewis) were performed in either heterotopic (n = 4) or orthotopic (n = 7) locations to establish the surgical technique. Composite auricle allografts were harvested and transplanted based on the posterior facial vein, the external carotid artery, and the great auricular nerve. A plastic square mold sutured over the transplants was used to prevent mechanical trauma to the transplants. Cyclosporine A initiated as 16 mg/kg/day for 2 weeks and tapered to a dosage of 8 mg/kg/day for another 2 weeks was the only immunosuppression regimen. RESULTS: All allografts survived with perfect viability for the follow-up period of 30 days. There were no signs of rejection, infection, or graft-versus-host disease, although significant weight loss was observed resulting from the immunosuppressive treatment. However, signs of rejection started 4 to 6 days after cessation of the cyclosporine A treatment, including edema, localized epidermal desquamation, and erythema formation that eventually progressed to necrosis within 11 to 14 days. The histologic outcomes were well correlated with the macroscopic appearance. CONCLUSIONS: It is feasible to elevate and transplant the composite auricle in ratsas a single neurosensorial facial subunit. A tapered dose of cyclosporine A from 16 mg/kg to 8 mg/kg allows maintaining allograft survival for 30 days across a strong major histocompatibility complex barrier. This model is reliable and reproducible and has the potential to be used for future immunologic studies to prevent or to induce transplantation tolerance.
Authors: Elie P Ramly; Rami S Kantar; Allyson R Alfonso; J Rodrigo Diaz-Siso; Eduardo D Rodriguez Journal: Plast Reconstr Surg Glob Open Date: 2019-09-23