Using a genetically defined rat model for the heterotopic
transplantation of a vascularized knee in the rat, histological and
histochemical studies of acute rejection in vascularized allografts of bone
were carried out. The graft consisted of the knee joint with the distal end
of the femur, the proximal part of the tibia, the cartilaginous growth
plates, the articular cartilage, and a minimum cuff of muscle, which was
transferred to a location under the abdominal skin. A total of 160
transplants, including vascularized and non-vascularized isografts,
vascularized and non-vascularized allografts that were transplanted across
a strong histocompatibility barrier, and vascularized allografts of bone
that were transplanted across a weak histocompatibility barrier, were
studied by light microscopy at intervals for as long as twelve weeks after
transplantation. Vascularized allografts of bone that were transplanted
across a strong histocompatibility barrier showed evidence of rapid
rejection, similar to that after transplantation of allografts of visceral
organs. This was manifested at one week by necrosis of osteocytes,
cessation of microcirculatory flow, massive extravasation of red cells, and
deposition of fibrin in the marrow. The large vessels demonstrated changes
that were characteristic of vascular rejection. Allografts that were
transplanted across a weak histocompatibility barrier showed a more
gradual, less intense process of rejection that allowed observation of the
evolution of the process. In these grafts, the osteoblasts and marrow in
the primary spongiosa of the metaphysis were early targets of rejection, as
indicated by necrosis of osteoblasts, extravasation of red blood cells, and
deposition of fibrin in the marrow spaces. Loss of osteoblasts from the
surfaces of osteoid as well as from bone on spicules of calcified cartilage
resulted in the cessation of new-bone formation. Calcification of the
longitudinal septa between the lowermost hypertrophic chondrocytes was
decreased. However, the proliferation and maturation of chondrocytes in the
zone of proliferating chondrocytes and in the upper hypertrophic zone
continued and resulted in the formation of a thickened growth plate. The
loss of osteocytes in other areas of the graft occurred later and only in
the areas where the microcirculation had been lost. These data suggest that
ischemic damage, which is probably secondary to an immune-related vascular
compromise, is a significant factor in the failure of grafts. In the grafts
that were transplanted across a weak histocompatibility barrier, the growth
of new bone and revascularization by the host occurred by twelve weeks.