Utility Of Ultrasound Biomicroscopy For Radiation-free Monitoring Of Facial Allografts
Maximilian Kueckelhaus, MD1, Amir Imanzadeh, MD2, Kanako Kumamaru, MD, PhD2, Muayyad M. Alhefzi, MD1, Nicole Wake, MS3, Ericka M. Bueno, PhD1, Sebastian Fischer, MD1, Mario Aycart, MD1, Alexander Dermietzel, BS1, Marie D. Gerhard-Herman, MD4, Frank J. Rybicki, MD, PhD2, Bohdan Pomahac, MD1.
1Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 3Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University School of Medicine, New York City, NY, USA, 4Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Chronic rejection (CR) leading to allograft loss remains a significant concern after facial allotransplantation. CR may occur without clinical signs or symptoms. The current means of monitoring is histological analyses of allograft biopsies, which is both invasive and impractical. Prior data suggest CR is associated with changes in intima and media thickness of vessels in arms and solid organ allografts; such data has not been published for face transplant recipients.
We used a 48 MHz transducer (UBMplus, Accutome, Malvern, PA) to acquire images of the bilateral facial (FA), radial (RA), dorsalis pedis and, if applicable, sentinel flap arteries in 5 face transplant recipients (8 months - 4.5 years post transplant) and 5 control subjects. We assessed the intima, media and adventitia thickness plus lumen and the total vessel diameter and area.
Face transplant recipients had thicker intima in all sites compared with controls, but the ratio of the intimal thickness of FA and RA was similar in face transplant recipients when compared to controls (1.00 vs. 0.95, p=0.742). Intra-observer correlation showed reliable reproducibility of the measurements (r=0.935, p<0.001). Inter-observer correlation demonstrated reproducipility of intima measurements (r=0.422, p<0.001).
We demonstrate that UBM is feasible for post surgical monitoring, and we have developed a new benchmark parameter, the FA/RA- intimal thickness ratio, to be used in future testing in the setting of CR.
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