Coating with paclitaxel improves graft survival in a porcine model of haemodialysis graft stenosis

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2007-10, Vol.22 (10), p.2800-2804
• Main Authors: Lee, Byung Ha, Lee, Jung Eun, Lee, Kwang Woong, Nam, Hye Yeong, Jeon, Hyun Jung, Sung, Young Ju, Kim, Jong Sung, Lim, Hyun Jung, Park, Jong-sang, Ko, Jai Young, Kim, Dae Joong
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Coated Materials, Biocompatible; Constriction, Pathologic; Disease Models, Animal; Diseases of the cardiovascular system; Emergency and intensive care: renal failure. Dialysis management; graft; Graft Rejection; Graft Survival; haemodialysis; Intensive care medicine; Male; Medical sciences; paclitaxel; Paclitaxel - administration & dosage; polytetrafluoroethylene; Polytetrafluoroethylene - chemistry; Prosthesis Design; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Renal Dialysis - instrumentation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Swine; Time Factors; Tubulin Modulators - administration & dosage; vascular access
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm438

Background. Most commonly resulting from intimal hyperplasia at the venous anastomosis, stenosis leading to thrombosis is a major cause of failure of polytetrafluoroethylene (PTFE) dialysis grafts. We recently reported that coating haemodialysis grafts with paclitaxel could reduce neointimal hyperplasia. This study tested whether paclitaxel-coating could prolong graft survival in a porcine model. Methods. PTFE grafts were double-coated with paclitaxel. Bilateral grafts were created between the carotid arteries and the external jugular veins, and we evaluated graft survival by weekly measurements of blood flow for 12 weeks. Results. We successfully implanted four pairs of paclitaxel-coated grafts and four pairs of control grafts in eight Landrace pigs. One control pig had to be euthanized at 4 weeks after graft placement. The grafts in the other three controls and four paclitaxel pigs survived until harvesting of the grafts. All paclitaxel-coated grafts remained patent for 12 weeks without decrease of blood flow. Median blood flow was 702 ml/min at three weeks and 818 ml/min at 12 weeks after placement. In contrast, the four control grafts lost luminal patency at 5, 6, 6 and 8 weeks, respectively. In Kaplan–Meier analysis, paclitaxel-coated grafts showed better survival than uncoated grafts (P = 0.011). Conclusions. Double-coating with paclitaxel improved graft survival. Coated PTFE grafts may be effective for the prevention of graft failure in patients on haemodialysis.