Can donated veins be used for vascular transplant?

Use of Donated Veins for Vascular Transplant

Yes, donated veins can be used for vascular transplant, with cryopreserved or fresh arterial allografts and autogenous venous grafts representing established options for vascular reconstruction, particularly in infected graft scenarios and select transplant situations. 1

Primary Applications and Evidence

Vascular Graft Infections and Reconstruction

Cryopreserved arterial allografts are an established option for in situ vascular reconstruction, particularly when dealing with infected synthetic grafts. 1 The American Heart Association guidelines specifically recognize these allografts as having:

• Lower reinfection rates compared to synthetic materials (P<0.05), with outcomes closely following autogenous venous grafts 1
• Fewer conduit failures and better overall outcomes compared to extra-anatomic revascularization 1
• Lower late mortality rates when compared to synthetic alternatives 1

Limitations of Arterial Allografts

Important caveats exist that must be considered in clinical decision-making:

• Complication rates of 16-23%, including intraoperative rupture due to friability and anastomotic bleeding 1
• Not suitable for emergency procedures because they must be preordered, and appropriate sizing may not be available 1
• Graft degeneration occurs over time, resulting in lower long-term patency compared to autogenous venous grafts 1, 2
• Contraindicated in MRSA, Pseudomonas, or multidrug-resistant infections 1, 2

Immunosuppression Considerations

Most authorities do not recommend immunosuppressive therapy to prevent rejection in patients receiving cryopreserved or fresh arterial allografts, based on concerns that infection risk would be increased. 1

Transplant-Specific Applications

Renal Transplantation

Autologous saphenous vein grafts (not donated veins) are occasionally used in renal transplant recipients, particularly with short donor vessels or after donor vessel injury. 3, 4 However:

• Autologous saphenous vein graft aneurysm formation is a recognized late complication, with surveillance recommended no later than 10 years after implantation 3
• Spiral vein graft techniques have been described for lengthening short living donor kidney vessels 4

Emerging Technologies

Recent research demonstrates that tissue-engineered veins using decellularized donor vessels reconditioned with recipient blood show promise, with full patency and no rejection signs in animal models. 5 Additionally, replacement of donor endothelial cells with recipient-derived cells in chimeric vessels may reduce immunological challenges, as autologous endothelial cells are spared from antibody-mediated rejection. 6

Clinical Decision Algorithm

When donated veins/arteries are considered for vascular reconstruction:

1. First-line: Autogenous venous graft (patient's own vein) - lowest infection rate, best long-term outcomes 1

   • Contraindications: History of deep vein thrombosis, inability to tolerate prolonged surgery, MRSA/Pseudomonas infections 1

2. Second-line: Cryopreserved arterial allograft (donated artery) - when autogenous vein unavailable 1

   • Advantages: Lower infection rate than synthetic materials, can be used in some aortoenteric fistulae 1
   • Contraindications: Emergency surgery, MRSA/Pseudomonas/multidrug-resistant organisms 1

3. Third-line: Rifampin-bonded synthetic grafts - when biological options exhausted or emergency surgery required 1

   • Higher infection rates but shorter operative time 1, 2

Critical Pitfalls to Avoid

• Do not use arterial allografts in emergency situations - they require preordering and may not be available in appropriate sizes 1
• Avoid in patients with MRSA, Pseudomonas, or multidrug-resistant infections - use extra-anatomic bypass instead 1
• Do not administer immunosuppression to prevent allograft rejection due to increased infection risk 1
• Anticipate 16-23% complication rates including intraoperative rupture and anastomotic bleeding 1