Background: Graft vasculopathy (GV) has been described in animal models and in some clinical cases of upper extremity and face transplantations, resulting in graft dysfunction and loss.
Methods: A prospective study has been performed to investigate intimal media thickness (IMT) of radial and ulnar arteries in the recipient and in the grafted extremities. Seven bilateral hand allotransplantations, six men and one woman, performed between January 2000 and November 2016 were included in the present study as well as seven matched controls. All the subjects have undergone high frequency ultrasonography (Philips iU22 with probe L15-7io) at least once a year since September 2012.
Results: There was not a significant difference (exact test on signed ranks) between the recipient and the grafted arteries of the transplanted patients: the mean IMT was 0.23 mm (0.18-0.26) in the recipient arteries and 0.28 mm (0.24-0.36) in the grafted arteries, although the values were higher in the grafted arteries particularly in the patient who developed a GV leading to graft loss. Indeed, this patient showed, in all the points of the follow-up, higher values of IMT in all the grafted arteries compared to the other grafted patients (p<0.001 Mann Whitney Exact Test). It is interesting to remark that IMT values in this patient were significantly higher before to show any clinical signs of GV and/or alterations in the angiography. All the other transplanted patients showed higher values of IMT compared to the control subjects (overall mean IMT for controls and transplanted patients was: 0.23 mm for control arteries while 0.24 and 0.28 mm for control and grafted arteries respectively) although this difference was not significant.
Conclusion: On the basis of these data we have shown only a trend towards higher values of IMT in the arteries of the grafts compared to the recipient arteries while the patient who developed a GV showed significant higher value, suggesting that increased IMT is early marker of GV.