BACKGROUND: Among the most common complications associated with abdominal organ transplantation are issues with abdominal wall closure. This difficulty, along with the recent rise in the use of vascularized composite allotransplantation, has led surgeons to the notion of abdominal wall transplantation. METHODS: The authors have developed a novel surgical model for a full-thickness total abdominal wall transplant based on a unilateral pedicle between fully major histocompatibility complex-mismatched rat strains. An established cuff technique was used to anastomose the donor's common iliac vessels to the recipient's femoral vessels. Three groups (n = 6 per group) received FK506 monotherapy, 0.25, 0.50, or 0.75 mg/kg per day. The transplants were assessed daily for evidence of rejection by visual inspection. Hematoxylin and eosin skin biopsies and fluorescence-activated cell sorting analysis of the recipients' peripheral blood were performed. RESULTS: No signs of rejection were observed in the animals receiving FK506, 0.50 or 0.75 mg/kg per day. Those receiving 0.25 mg/kg per day, however, displayed a mixed rejection response. Flow cytometric analysis did not show evidence of donor-specific chimerism. CONCLUSIONS: A full-thickness abdominal wall graft based on a unilateral pedicle is a technically feasible and reliable small-animal surgical model. The use of greater than or equal to 0.50 mg/kg per day FK506 results in 100 percent graft survival. Future plans are to use this model to investigate the immunologic interaction of a concomitant solid organ and an abdominal wall allograft, as would likely occur in the clinical situation.
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