Clinical outcome following nerve allograft transplantation

The clinical outcome of seven patients who underwent reconstruction of long upper- and lower-extremity peripheral nerve gaps with interposition periph eral nerve allografts is reported. Patients were selected for transplantati on when the nerve gaps exceeded the length that could be reconstructed with available autograft tissue. Before transplantation, cadaveric allografts w ere harvested and preserved for 7 days in University of Wisconsin Cold Stor age Solution at 5 degreesC. In the interim, patients were started on an imm unosuppressive regimen consisting of either cyclosporin A or tacrolimus (FK 506), azathioprine, and prednisone. Immunosuppression was discontinued 6 mo nths after regeneration across the allograft(s) was evident. Six patients d emonstrated return of motor function and sensation in the affected limb, an d one patient experienced rejection of the allograft secondary to subtherap eutic immunosuppression. In addition to providing the ability to restore ne rve continuity in severe extremity injuries, successful nerve allografting protocols have direct applicability to composite tissue transplantation.