Allograft Slings

Allografts are tissues harvested from a human donor, which are transplanted into human recipients. Allograft materials were introduced in an attempt to decrease morbidity associated with harvesting autologous slings. Human cadaveric fascia and cadaveric dermis are now the two most often used allograft materials. Organic materials seem to be a good choice for the sling because of lower risk of erosion. The allograft is obtained from a licensed tissue bank regulated by the American Association of Tissue Banks (AATB). A multistep sterilization process is conducted to eliminate risk of disease transmission. A graft's processing may affect its quality. Failure caused by graft degradation is more common with fresh frozen irradiated grafts than with chemically processed grafts. The latter retain their quality and architecture more readily.

Donor and recipient matching is not required, although presence of DNA material has been reported in some commercially available cadaveric allografts. The clinical significance of this DNA material is undetermined. Although the risk of disease transmission is remote, it is imperative that it be explained to patients. Several studies have attempted to quantify this risk. Only one case of transmission of the human immunodeficiency virus (HIV) has been reported from tissue (not fascia) transplantation since screening for HIV and other viral pathogens was initiated. If guidelines for tissue banking set forth by the Food and Drug Administration are followed, risk of acquiring tissue from a donor with HIV is estimated at 1 of 1667600. By comparison, risk of HIV infection from a blood transfusion is much higher than from tissue transplant.7

Another potential risk of cadaveric fascia transplantation is transmission of prion diseases. Prions are protein molecules associated with transmission of spongiform encephalopathy. The most common form of this encephalopathy is Creutzfeldt-Jacob disease. A literature review did not document spongiform encephalopathy associated with cadaveric fascia lata or dermis.8

Allograft fascia lata slings have been proven as efficacious as autologous fascia in short-term follow-up studies.9 Long-term follow-up and evaluation are required. Processed dermal matrix is a human cadaveric allograft available under the brand names DuraDermâ„¢ (C.R. Bard Inc., Murray Hill, NJ) and UrogenTM (AMS, Minnetonka, MN). The acellular collagen matrix contains proteins, pro-teoglycans, and other ground substances, and serves as structural support for effective ingrowths of the host's collagen. Being acellular serves to eliminate immune response, and tissue rejection. Repliformâ„¢ (LifeCell Corp., Branchburg, NJ) is an acellular human dermal matrix allo-graft that is available for tissue reinforcement in pelvic floor and incontinence surgery.

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