The Role of Cyclosporine A in the Treatment of Prosthetic Vascular Graft Infections with the Use of Arterial Homografts

Abstract

Infections of prosthetic grafts in vascular surgery are the cause of many serious postoperative complications including death (Bahnini et al.,1991; Callow,1996; Wilson,2001; YeagerP Methe et al.,2007; Paul et al.,1985; Pober et al.,1984). Moreover, organ donors should be selected with respect to histocompatibility and blood group types (Gabriel et al.,2002; Mirelli et al.,1998, 1999; Scolari et al.,1998). Experimental studies show that immunosuppressive treatment is helpful after the implantation of cold-preserved fresh arterial homografts (Azuma et al.,1999; Gabriel&Fandrich,2002). On the other hand, there is a concern that immunosuppressive drugs can exacerbate the infection. There are no clinical studies examining the need to use immunosuppression after the transplantation of fresh arterial homografts in prosthetic graft infections (Mirelli et al.,1999). We assumed that administration of Cyclosporine A with a concomitant antibiotic therapy may improve the viability of the fresh arterial homografts and improve the patients’ condition. One of the diagnostic methods used to detect infections in vascular surgery is scintigraphy with the use of Technetium-99m labeled leucocytes. Leucocytes migrate and accumulate in the infected area allowing for the area of accumulation to be estimated (Plissonnier et al.,1995). Objective monitoring of the infection after an arterial graft implantation facilitates the decision of choosing the right treatment, especially for patients treated with immunosuppressive drugs. The aim of our study was to assess the influence of Cyclosporine A administration on the outcome of patients who underwent fresh arterial homograft transplantation in the treatment of prosthetic graft infections.