Abstract
Allogeneic transplantation of human cancellous and cortical bone is a controversially discussed concept in trauma and orthopaedic surgery. Biological and immunological arguments support transplantation of autologous material whenever this is technically possible. On the other hand, synthetic alloplastic materials for bone substitution are available free of immunological and hygienic hazards. In this context the value of allogeneic bone grafts is discussed, especially considering the problem of AIDS. If autologous corticospongious bone is to be used its supply is limited. On the other hand, alloplastic synthetic artificial bone does not meet all the requirements demanded for substitution of large osseous defects up to now. The problems of geometric and mechanical stability of these alloplastic materials still remain. Therefore, no alternative to allografting of large, stable, corticospongious fragments exists in some cases. Bone transplantation is performed without vital indication in nearly every case. Thus an optimum of hygienic security has to be claimed for recipients of allogeneic bone. The “Munich model” for bone transplantation is presented and discussed.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Aebi M, Schwarzenbach O, Regazzoni P, Rahn BA (1988) Experimentelle segmentale Knochentransplantation. In: Hackenbroch MH, Refior HJ, Wirth CJ (eds) Knorpel- und Knochentransplantation. Thieme, Stuttgart, pp 56–60
Ascherl R, Morgalla H, Geissdörfer K, Schmeller ML, Langhammer H, Lechner F, Blümel G (1986) Experimentelle Untersuchungen und klinische Aspekte zur Kältekonservierung allogener Spongiosa. Orthopäde 15:22–29
Ascherl R, Back G, Lechner F, Blumel G (1987) Clinical applications of cryopreserved allogeneic bone. Low Temp 13:105–106
Boer H de (1989) Early research on bone transplantation. In: Aebi M, Regazzoni P (eds) Bone transplantation. Springer, Berlin Heidelberg New York, pp 7–19
Bowen PA, Lobel SA, Caruana RJ, Leffell MS, House MA, Rissing JP, Humphries AL (1988) Transmission of human-immunodeficiency virus (HIV) by transplantation: clinical aspects and time course analysis of virus antigenemia and antibody production. Ann Intern Med 108:46–48
Buck BE, Malinin TI, Brown MD (1989) Bone transplantation and human immunodeficiency virus. Clin Orthop 240:129–136
Bundesgesundheitsamt und Wissenschaftlicher Beirat der Bundesärztekammer (1990) Richlinien zum Führen einer Knochenbank. Dtsch Aerztebl 87:41–44
Burchard H (1983) The biology of bone graft repair. Clin Orthop 174:28–142
Caffiniere JY de la, Martin E, Humbel R, Konsbruck R (1982) Role de lépaisseur des greffons dans láutotransplantation osteocartilagineuse du genou le lapin. Int. Orthop 15–25
Centers for Disease Control (1985) Testing donors of organs, tissues and semen for antibody to human t-lymphotropic virus type II/lymphadenopathy-associated virus. Morb Mortal Wkly Rep 34:294
Centers for Disease Control (1987) Human immunodeficiency virus infection transmitted from an organ donor screened for HIV antibody — North Carolina. Morb Mortal Wkly Rep 36:306–308
Centers for Disease Control (1988) Transmission of HIV through bone-transplantation: case report and public health recommendations. Morb Mortal Wkyl Rep 37:597–599
Costagliola D, Mary JY, Brouard N, Laporte A, Valleron AJ (1989) Incubation time for AIDS from French transfusion-associated cases. Nature 338:768–769
Dolan CT, Brown AL, Ritts RE (1971) Microbiological examination of postmortem tissues. Arch Pathol 92:206
Doppelt SH, Tomford WW, Cucas AD, Mankin HJ (1981) Operational and financial aspects of a hospital bone bank. J Bone Joint Surg [Am] 63:1472–1481
Friedlaender GE (1982) Current concepts review bone-banking. J Bone Joint Surg [Am]:307–311
Furlini G, Re MC, Bandini G, Albertazzi L, La Placa M (1988) Antibody response to human immunodeficiency virus after infected bone marrow transplantation. Eur J Clin Microbiol Infect Dis 7:664–666
Hertlein H, Mittlmeier T, Piltz S, Schürmann M, Kauschke T, Lob G (1992) Spinal stabilisation for patients with metastatic lesions of the spine using a titanium spacer. Eur Spine J 1:131–136
Hofmann GO (1991) Immunologischer und hygienischer Stellenwert der allogenen Knochentransplantation für die Wiederherstellungschirugie. Aktuel Chir 26:126–133
Hofmann GO (1992) Allogene Knochentransplantation. In: Mime H, Junginger T (eds) Jahrbuch der Chirurgie 1992. Biermann, Zülpich, pp 131–142
Hofmann GO, Mittlmeier T, Lob G (1990) Logistik und Management einer Knochenbank im Verbund mit einem Transplantationszentrum. Tagungsband, 26th Jahrestagung der Deutschen Gesellschaft für Plastische und Widerherstellungschirurgie. Karl Sasse, Rotenburg/Wümmme, pp 280–283
Hofmann GO, Lob G, Mittlmeier T, Merkle R (1990) Transplantation allogener cortico-spongiöser Späne in der Tumorchirurgie des Skeletts. Tagungsband, 26th Jahrestagung der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie. Karl Sasse, Rothenburg/Wümme, pp 309–311
Kearney JN (1987) Allografts as vectors for infection. Lancet 11:400–403
Klatzmann D, Laporte JP, Brisson AA, Gruest J, Montagnier L, Gluckman JC (1987) Cyclosporin A treatment for human immunodeficiency virus-infected transplant recipients. Transplant Proc 19:1828
Knaepler H, Garrel T von, Seipp HM, Ascherl R (1992) Experimentelle Untersuchungen zur thermischen Desinfektion und Sterilisation allogener Knochentransplantate und deren Auswirkung auf die biologische Wertigkeit. Unfallchirurg 95:477–484
L'Age-Stehr J, Schwarz A, Offermann G, Langmaak H, Bennhold I, Niedrig M, Koch MA (1985) HTLV-III infection in kidney transplant recipients. Lancet 2:1361–1362
Macewen W (1981) Observations concerning transplantation of bone. Illustrated by a case of inter-human osseous transplantation, whereby over two-thirds of the shaft of a humerus was restored. Proc Soc Lond [Biol] 32:232
Margreiter R, Fuchs D, Hausen A, Hengster P, Schönitzer D, Spielberger M, Dierich MP, Wachter H (1986) HIV infection in renal allograft recipients. Lancet II:398
Neumayer HH, Wagner K, Kresse S (1986) HTLV III antibodies in patients with kidney transplants or on haemodialysis. Lancet 1:496–497
Prompt CA, Reis MM, Grillo FM, Kopstein J, Kraemer E, Manfro RC, Maia MH, Comiran JB (1985) Transmission of AIDS virus at renal transplantation. Lancet 2:672
Rosenberger J, Helling HJ, Zieren HU (1990) Die malignen pathologische Frakturen. Dtsch Aertzebl 87:335–343
Rosso R, Schäfer D, Fricker R, Schläpfer R, Brennwald J, Heberer M (1993) Experimentelle vaskularisierte Kniegelenkstransplantation an einem Hundemodell: Frühergebnisse nach Allotransplantation und Replantation. Langenbecks Arch Chir (Chir Forum 1993). Springer, Berlin Heidelberg New York, S363–367
Rubin RH, Tolkoff-Rubin NE (1988) The problem of immunodeficiency virus (HIV) infection and transplantation. Transplant Int 1:36–42
Rudolph H (1987) AIDS-Prophylaxe in Krankenhaus und Praxis. Empfehlungen des deutschsprachigen Arbeitskreises für Krankenhaushygiene. Chirurg 58:845–847
Rudolph H, Werner HP (1987) AIDS-Prophylaxe in Krankenhaus und Praxis. Hygiene and Medizin, Special issue
Rudolph H, Werner HP (1990) Empfehlungen zur Durchführung allogener Knochentransplantationen. Hygiene und Medizin 15:5–6
Samuel D, Castaing D, Adam R, Saliba F, Chamaret S, Misset JL, Montagnier L, Bismuth H (1988) Fatal acute HIV infection with anaplastic anaemia, transmitted by liver graft. Lancet 1:1221–1222
Schwarzenbach O, Aebi M, Czitrom AA (1988) Allogene Knochentransplantate nach in vitro Kultur. In: Hackenbroch MH, Refior HJ, Wirth CJ (eds) Knorpel- und Knochentransplantation. Thieme, Stuttgart, pp 61–65
Siegling CW, Krzok G, Franz R (1988) Vitale autogene und allogene Halbgelenkstransplantate am Menschen (Langzeitbeobachtung). In: Hackenbroch MH, Refior HJ, Wirth CJ (eds) Knorpel- und Knochentransplantation. Thieme, Stuttgart, pp 50–55
Simonds RJ, Holmberg SD, Hurwitz RL, Coleman TR, Bottenfield S, Conley LJ, Kohlenberg SH, Castro KG, Dahan BA, Schable CA, Rayfield MA, Rogers MF (1992) Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med 326:726–732
Tomford WW, Doppelt SH, Mankin HJ, Friedlaender GE (1983) 1983 Bone Bank Procedures. Clin Orthop 174:15–21
Veen MR, Bloem PM, Persijin GG (1990) A central bone bank for bone transplantations. (in Dutch) Ned Tijdschr Geneeskd 134:988–991
Vilmer E, Rouzioux C, Barre F, Cherman JC, Gluckman JC, Devergie A, Montagnier L, Gluckman E (1986) Screening for lymphadenopathy/AIDS virus in bone marrow transplant recipients. N Engl J Med 314:1252
Walther P von (1821) Wiedereinheilung der bei der Trepanation ausgebohrten Knochenscheibe. J Chir Augenheilkd 2:571
Ward JW, Deppe DA, Samson S, Perkins H, Holland P, Fernando L, Feorino PM, Thompson P, Kleinman S, Allen J (1987) Risk of human immunodeficiency virus infection from blood donors who later developed the acquired immunodeficiency syndrome. Ann Intern Med 196:61–62
Ward JW, Holmberg SD, Allen JR, Cohn DL, Critchley SE, Kelinman SH, Lenes BA, Ravenholt O, Davis JR, Quinn MG, Jaffe HW (1988) Transmission of human immunodeficiency virus (HIV) by blood transfusion screened as negative for HIV antibody. N Engl J Med 318:473–487
Ward JW, Bush TJ, Perkins HA, Lieb LE, Allen JR, Goldfinger D, Samson SM, Pepkowitz SH, Fernando LP, Holland PV, Kleinman SH, Grindon AJ, Garner JL, Rutherford GW, Holmberg SD (1989) The natural history of transfusion-associated infection with human immunodeficiency virus. N Engl J Med 321:947–952
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hofmann, G.O., Kirschner, M.H., Wangemann, T. et al. Infections and immunological hazards of allogeneic bone transplantation. Arch Orthop Trauma Surg 114, 159–166 (1995). https://doi.org/10.1007/BF00443390
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00443390