{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:52:03Z","timestamp":1791525123757,"version":"4.3.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"\n Introduction<\/jats:title>\n Cryopreserved arterial allografts are an established conduit for vascular reconstruction in patients with vascular graft infection (VGI). Although outcomes after aortic and peripheral implantation have been reported separately, comparative data including donor- and graft-specific characteristics are limited. This study compared clinical, procedural, and donor-related factors between aortic and non-aortic allograft implantation and evaluated their association with postoperative outcomes.<\/jats:p>\n <\/jats:sec>\n \n Materials and methods<\/jats:title>\n \n This retrospective single-center study included all consecutive patients undergoing arterial allograft implantation between January 2023 and December 2025. Patients were stratified into aortic position (AP;\n n<\/jats:italic>\n \u2009=\u200922) and non-aortic position (NAP;\n n<\/jats:italic>\n \u2009=\u200929). Clinical, procedural, microbiological, donor-, and graft-specific variables were analyzed. Primary endpoints were in-hospital and 30-day mortality. Secondary endpoints included overall survival, primary graft patency, limb salvage and reintervention.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Fifty-one patients received 112 cryopreserved arterial allografts in multisegment reconstructions. VGI was present in 76.5% of patients. Compared with NAP, AP reconstruction required longer operative time (343 vs. 262\u2005min,\n p<\/jats:italic>\n \u2009=\u2009.002) and greater blood loss (1,125 vs. 550\u2005mL,\n p<\/jats:italic>\n \u2009=\u2009.001). In-hospital\/30-day mortality was higher after AP reconstruction (22.7% vs. 3.5%,\n p<\/jats:italic>\n \u2009=\u2009.073), whereas primary graft patency and reintervention rates were comparable. Kaplan\u2013Meier analysis demonstrated significantly reduced survival after aortic reconstruction (log-rank\n p<\/jats:italic>\n \u2009=\u2009.011). Donor age, sex, graft storage duration, and transport characteristics were similar between groups. Non-aortic allografts showed significantly better histological quality (\n p<\/jats:italic>\n \u2009=\u2009.012).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Aortic allograft reconstruction was associated with greater procedural complexity and reduced overall survival, likely reflecting the severity of underlying disease and extent of surgery. Histological graft quality differed significantly between implantation sites and may represent an underrecognized determinant of allograft outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Cryopreserved arterial allografts provide effective vascular reconstruction in both aortic and non-aortic positions, with favorable graft patency. Inferior survival after aortic reconstruction occurred despite largely comparable donor characteristics, aside from a higher histological quality grade in NAP. This finding is hypothesis-generating and warrants further evaluation. Prospective multicenter studies should determine whether histological graft assessment improves allograft selection and predicts long-term outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1957142","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:34:20Z","timestamp":1791524060000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Aortic versus non-aortic cryopreserved allograft and donor-specific outcome: a retrospective observational study"],"prefix":"10.3389","volume":"13","author":[{"given":"Matthias","family":"Buerger","sequence":"first","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Schneider","sequence":"additional","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Institute of Medical Sociology and Rehabilitation Science","place":["Berlin, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Bartholom\u00e9","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Pauli","sequence":"additional","affiliation":[{"name":"Clinic for Angiology, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Bonietzki","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorben","family":"Michaelis","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Rusch","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grischa","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Rusch","sequence":"additional","affiliation":[{"name":"Clinic for Vascular Surgery, Medical School and University Medical Centre OWL","place":["Bielefeld, North Rhine-Westphalia, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kapahnke","sequence":"additional","affiliation":[{"name":"Clinic for Vascular and Endovascular Surgery, University Hospital of Schleswig-Holstein","place":["Kiel, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.ejvs.2019.10.016","article-title":"Editor's choice - European society for vascular surgery (ESVS) 2020 clinical practice guidelines on the management of vascular graft and endograft infections","volume":"59","author":"Chakf\u00e9","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e412","DOI":"10.1161\/CIR.0000000000000457","article-title":"Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association","volume":"134","author":"Wilson","year":"2016","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1093\/ejcts\/ezy263","article-title":"Twenty-year experience with cryopreserved arterial allografts for vascular infections","volume":"55","author":"Mestres","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.jvs.2025.03.182","article-title":"Outcomes of native or graft abdominal aortic infection managed with orthotopic xeno pericardial grafts or cryopreserved allograft","volume":"82","author":"Battistella","year":"2025","journal-title":"J Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.avsg.2023.03.005","article-title":"A systematic review of in-situ aortic reconstructions for abdominal aortic graft and endograft infections: outcomes of currently available options for surgical replacement","volume":"95","author":"Colacchio","year":"2023","journal-title":"Ann Vasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e112947","DOI":"10.1371\/journal.pone.0112947","article-title":"Surgical and antimicrobial treatment of prosthetic vascular graft infections at different surgical sites: a retrospective study of treatment outcomes","volume":"9","author":"Erb","year":"2014","journal-title":"PLoS One"},{"key":"B7","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1016\/j.avsg.2018.09.015","article-title":"Infections of prosthetic grafts and patches used for infrainguinal arterial reconstructions","volume":"57","author":"Etkin","year":"2019","journal-title":"Ann Vasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1177\/17085381221141118","article-title":"Risk factors for elective and urgent open conversion after EVAR-a retrospective observational study","volume":"32","author":"Haidar","year":"2024","journal-title":"Vascular"},{"key":"B9","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.athoracsur.2018.03.014","article-title":"Long-term outcome of homograft implants related to donor and tissue characteristics","volume":"106","author":"Axelsson","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"Von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1016\/j.ejvs.2016.09.007","article-title":"Diagnosis of aortic graft infection: a case definition by the management of aortic graft infection collaboration (MAGIC)","volume":"52","author":"Lyons","year":"2016","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1007\/s00772-017-0274-7","article-title":"Cryopreserved vascular grafts from human tissue","volume":"6","author":"Schulte","year":"2017","journal-title":"Gef\u00e4sschirurgie"},{"key":"B13","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.ejvs.2019.03.003","article-title":"Editor's choice - cryopreserved allografts for arterial reconstruction after aorto-iliac infection: a systematic review and meta-analysis","volume":"58","author":"Antonopoulos","year":"2019","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.ejvs.2014.04.023","article-title":"In situ reconstruction in native and prosthetic aortic infections using cryopreserved arterial allografts","volume":"48","author":"Touma","year":"2014","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.ejvs.2021.02.036","article-title":"Short and mid term outcomes of cryopreserved abdominal aortic allografts used as a substitute for infected prosthetic grafts in 200 patients","volume":"62","author":"Couture","year":"2021","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1016\/j.jvs.2017.06.088","article-title":"Cryopreserved arterial allografts for in situ reconstruction of abdominal aortic native or secondary graft infection","volume":"67","author":"Ben Ahmed","year":"2018","journal-title":"J Vasc Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/j.jvs.2020.12.071","article-title":"Microbial evolution of vascular graft infections in a tertiary hospital based on positive graft cultures","volume":"74","author":"Gouveia e Melo","year":"2021","journal-title":"J Vasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"100607","DOI":"10.1016\/j.pcorm.2025.100607","article-title":"Clinical and structural outcomes of hybrid operating rooms in adult cardiac surgery: a systematic review","volume":"42","author":"Pourdel","year":"2026","journal-title":"Perioper Care Oper Room Manag"},{"key":"B19","doi-asserted-by":"publisher","first-page":"100645","DOI":"10.1016\/j.pcorm.2026.100645","article-title":"The empty chair: OR nurse retention as a patient safety imperative","volume":"43","author":"Hosseini","year":"2026","journal-title":"Perioper Care Operat Room Manag"},{"key":"B20","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1016\/j.jvs.2018.10.111","article-title":"Peripheral artery reconstructions using cryopreserved arterial allografts in infected fields","volume":"70","author":"Furlough","year":"2019","journal-title":"J Vasc Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1111\/j.1469-0691.2011.03618.x","article-title":"Characteristics and prognosis in patients with prosthetic vascular graft infection: a prospective observational cohort study","volume":"18","author":"Legout","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"B22","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jvs.2004.09.025","article-title":"Cryopreserved arterial allograft reconstruction for peripheral graft infection","volume":"41","author":"Castier","year":"2005","journal-title":"J Vasc Surg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.jtcvs.2013.07.038","article-title":"Long-term clinical outcomes after aortic valve replacement using cryopreserved aortic allograft","volume":"148","author":"Fukushima","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1093\/icvts\/ivv151","article-title":"Gender mismatch in allograft aortic valve surgery","volume":"21","author":"B\u00f6ll","year":"2015","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.athoracsur.2024.01.021","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"118","author":"Czerny","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.avsg.2015.11.014","article-title":"Cryopreserved arterial allografts and ABO and rhesus compatibility","volume":"33","author":"Della Schiava","year":"2016","journal-title":"Ann Vasc Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2570","DOI":"10.1097\/01.ASN.0000030078.74889.69","article-title":"The effect of donor gender on graft survival","volume":"13","author":"Zeier","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"B28","first-page":"741","article-title":"Mineralization and organic phase modifications as contributory factors of accelerated degeneration in homograft aortic valves","volume":"12","author":"Lis","year":"2003","journal-title":"J Heart Valve Dis"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0255114","DOI":"10.1371\/journal.pone.0255114","article-title":"Cryopreservation moderates the thrombogenicity of arterial allografts during storage","volume":"16","author":"Hidi","year":"2021","journal-title":"PLoS One"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0230234","DOI":"10.1371\/journal.pone.0230234","article-title":"Influence of the new standardized clinical cryopreservation\/slow thawing protocol on immunogenicity of arterial allografts in rats","volume":"15","author":"Hruby","year":"2020","journal-title":"PLoS One"},{"key":"B31","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.jvs.2020.12.070","article-title":"Long-term results of cryopreserved allografts in aortoiliac graft infections","volume":"74","author":"Weiss","year":"2021","journal-title":"J Vasc Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1957142\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:34:21Z","timestamp":1791524061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1957142\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":31,"alternative-id":["10.3389\/fsurg.2026.1957142"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1957142","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"1957142"}}