Allograft survival prolongation after microsurgical lymphatic reconstruction in a short-term immunosuppressed rat small bowel transplantation model

Abstract

“It is clear, however, that today's discovery by bacteriologists, immunologists, biochemists, pathologists and other specialists have their origin in the questions raised by early surgical pioneers, whose primary concern was adequate wound coverage and healing.” This quotation by Felix T. Rapaport and plastic surgeon John Marquis Converse represents the early history of transplantation. “It remains there to this day and did him lasting good in many ways.” This statement by Sir Winston Churchill of his donation of a skin allograft to a brother officer in 1899 illustrates an example of allogeneic grafting without immunosuppression. “Their vasculature is established by direct end-to-end anastomosis of some at least of vessels in the graft with the vessels of the bed.” A quotation from Sir Peter Medawar's classic Harvey Lecture of March 21, 1957, describes the importance of vessel connections between the graft and the host to prevent rejection of allografts described by others. “Nature presents us with her protests against removing lymphatics, with her protests against any lymphatic malfunctioning.” Leo Clodius, who spent his career studying lymphatics, opened with these words a congress on lymphology in 1987. He referred later to the clinical lymphedema treatment by plastic and microsurgical operations. These four quotations demonstrate that (1) grafts can be transplanted allogeneically without immunosuppression; (2) they will not be rejected if no connection to the vascular system of the host take place, like in the brain; (3) but will be rejected if vessels of the host shoot up to the allograft; and (4) lymphatics also belong to a vascular system that transports immunological circulating cells. Interestingly, the possibility of microsurgical reconstructions of the lymphatic system is not seen to be necessary in transplantation today. It is unclear why the actual state of the art of microneurolymphovascular transplantation in plastic surgery is not considered in today's transplantation research.