Secondary lymphedema often develops after removal of lymph nodes in combination with radiation therapy, in particular in patients with breast cancer, inguinal cancer, cervical cancer and melanoma. No convincing treatment for the prevention and therapy of acquired lymphedema exists so far, therefore we wanted to show the reintegration of transplanted avascular lymph node fragments in the lymphatic system and positive effects of the transplanted fragments on the restoration of the lymphatic flow in this study. A total of 26 minipigs underwent lymphadenectomy of both groins. A minimum of one lymph node was retransplanted. The lymph nodes were cut into small pieces and retransplanted in the left groin (n = 17) or in both groins (n = 9). Different retransplantation techniques were investigated, transplantation of large versus small fragments, with and without capsule. The lymph flow was evaluated 5 and 8 months after surgery, using SPECT/CT and Berlin Blue. The results were confirmed by dissection. The lymph node transplants were assessed histologically. In contrast to the lymph flow in the transplanted groin, the lymph flow in the non-transplanted groin was often malfunctioning. Large lymph node fragments were found reintegrated in the lymphatic system more often than small slices of lymph node fragments. About 5 months after surgery impairment of lymph flow was seen especially after retransplantation of small slices of lymph node fragments. In seven out of eight minipigs a dermal backflow developed in the non-transplanted groin, 8 months after surgery. Only one minipig of these groups developed dermal backflow in both groins. All lymph node fragments showed an organized structure histologically. Autologous lymph node transplantation has positive effects on the regeneration of lymph vessels and restoration of lymph flow after lymphadenectomy.
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The excellent technical assistance of Andrea Herden and Karin Westermann and the polishing of the English by Sheila Fryk are gratefully acknowledged. This study was partly supported by the German Research Foundation (Cluster of Excellence “From Regenerative Biology to Reconstructive Therapy, REBIRTH”).
Damstra RJ, Voesten HG, van Schelven WD, et al (2008) Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 113:199–206. doi:10.1007/s10549-008-9932-5CrossRefPubMedGoogle Scholar
Tammela T, Saaristo A, Holopainen T et al (2007) Therapeutic differentiation and maturation of lymphatic vessels after lymph node dissection and transplantation. Nat Med 13:1458–1466. doi:10.1038/nm1689CrossRefPubMedGoogle Scholar
Szuba A, Pyszel A, Jedrzejuk D et al (2007) Presence of functional axillary lymph nodes and lymph drainage within arms in women with and without breast cancer-related lymphedema. Lymphology 40:81–86PubMedGoogle Scholar
Cheville AL, Das I, Srinivas S, et al (2009) A pilot study to assess the utility of SPECT/CT-based lymph node imaging to localize lymph nodes that drain the arm in patients undergoing treatment for breast cancer. Breast Cancer Res Treat. doi:10.1007/s10549-008-0283-zPubMedGoogle Scholar