Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels

Abstract

Vascular allografts have been used for many years in patients with infection complications and when the patient lacks own autologous venous material. Cryopreservation has permitted the long term storage of these allografts, offering the optimal solution for particular clinical situations. For more than 20years the European Homograft Bank has prepared, stored in the liquid nitrogen vapour below -130°C and distributed various types of the quality controlled arterial allografts throughout the European centers and elsewhere. The tissues are prepared according to the existing European, Belgian, Swiss and other EU countries' regulations and standards. This paper gives an overview of this activity since 1991. During this period 1,428 batches of arteries were received from recovery centres within European Union and Switzerland and 3,941 arterial segments were evaluated. 1,250 (32%) were discarded for morphological findings (58%), bacteriology (31%) and other reasons, while 2,685 or 68% (ascending and descending aorta, arch, aortic bifurcation, iliac and femoral arteries and the non-valved pulmonary bifurcations) were cryopreserved and stored. 2,506 arteries were implanted in 1,600 patients in vascular and cardiac centers in European Union and elsewhere. The most important indications were infections (65%), critical limb ischemia (15%) and congenital cardiac malformations (15%). Some allografts were used for the repair of arterial injury (2%) or prosthetic graft thrombosis (1.5%). 10 aortic allografts (0.4%) were used for tracheal replacement in case of cancer. In 52 cases EHB did not fulfill the surgeon's requests due to shortage of arterial allografts. Collaboration with vascular surgeons in the tissue recovery might improve the number, diversity and quality of vascular allografts. A multicentric study is necessary to evaluate the long-term outcome of these allografts.