NDT Advance Access originally published online on July 7, 2007
Nephrology Dialysis Transplantation 2007 22(10):2800-2804; doi:10.1093/ndt/gfm438
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Coating with paclitaxel improves graft survival in a porcine model of haemodialysis graft stenosis
1Clinical Research Center, Samsung Biomedical Research Institute, 2Division of Nephrology Samsung Medical Center, Sungkyunkwan University School of Medicine, 3Division of Transplantation Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 4Department of Chemistry and Molecular Engineering, Seoul National University and 5Mitech Co., Seoul, Korea
Correspondence and offprint requests to: Dae Joong Kim, MD, Division of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea 135-710. Email: kimdjsmc{at}dreamwiz.com
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Abstract |
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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.
Keywords: graft; haemodialysis; paclitaxel; polytetrafluoroethylene; vascular access
The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.
Received for publication: 14.12.06
Accepted in revised form: 11. 6.07