Extracorporeal Perfusion in Vascularized Composite Allotransplantation: Current Concepts and Future Prospects

Severe injuries of the face and limbs remain a major challenge in today's reconstructive surgery. Vascularized composite allotransplantation (VCA) has emerged as a promising approach to restore these defects. Yet, there are major obstacles preventing VCA from broad clinical application. Two key restrictions are (1) the graft's limited possible ischemia time, keeping the potential donor radius extremely small, and (2) the graft's immunogenicity, making extensive lifelong monitoring and immunosuppressive treatment mandatory. Machine perfusion systems have demonstrated clinical success addressing these issues in solid organ transplantation by extending possible ischemia times and decreasing immunogenicity. Despite many recent promising preclinical trials, machine perfusion has not yet been utilized in clinical VCA. This review presents latest perfusion strategies in clinical solid organ transplantation and experimental VCA in light of the specific requirements by the vascularized composite allograft's unique tissue composition. It discusses optimal settings for temperature, oxygenation, and flow types, as well as perfusion solutions and the most promising additives. Moreover, it highlights the implications for the utility of VCA as therapeutic measure in plastic surgery, if machine perfusion can be successfully introduced in a clinical setting.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Transplantation Surgery and Research Source Type: research

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This study describes a simple, reproducible, human model that allows for interrogation of flow effects during ex vivo organ perfusion. MATERIALS AND METHODS: Gonadal veins from deceased human renal allografts were subjected to either static cold storage or hypothermic machine perfusion for up to 24 hours. Caspase-3, Krüppel-like factor 2 expression and electron microscopic analysis were compared between 'flow' and 'no-flow' conditions, with living donor gonadal vein sections serving as negative controls. RESULTS: The increase in caspase-3 expression was less pronounced for hypothermic machine-perfused veins ...
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Conclusions. Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor.
Source: Transplantation - Category: Transplant Surgery Tags: Original Clinical Science—General Source Type: research
CONCLUSIONS Non-invasive investigations of the liver microcirculation and hemoglobin oxygenation were shown to be predictive factors for EAD following liver transplantation. PMID: 31417074 [PubMed - in process]
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Tags: Ann Transplant Source Type: research
Abstract BACKGROUND AND OBJECTIVES: Recent developments indicated that functional magnetic resonance imaging (MRI) could potentially provide noninvasive assessment of kidney interstitial fibrosis in patients with kidney diseases, but direct evidence from histopathology is scarce. We aimed to explore the diagnostic utilities of functional MRI for the evaluation of kidney allograft interstitial fibrosis. DESIGN, SETTING, PARTICIPANTS, &MEASUREMENTS: We prospectively examined 103 kidney transplant recipients who underwent for-cause biopsies and 20 biopsy-proven normal subjects with functional MRI. Histomorph...
Source: Clinical Journal of the American Society of Nephrology : CJASN - Category: Urology & Nephrology Authors: Tags: Clin J Am Soc Nephrol Source Type: research
Publication date: Available online 12 July 2019Source: Journal of Clinical and Experimental HepatologyAuthor(s): Prafulla V. Jadhav, Sunil Raviraj Kothakota, Madhu Sasidharan, Harish Kareem, Ajith K. NairIntroductionIschemia reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index, which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI.AimThe aim of this study was to determine the effect of type and grade of donor liv...
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
Publication date: Available online 12 July 2019Source: Journal of Clinical and Experimental HepatologyAuthor(s): Prafulla Vishnurao Jadhav, Kothakota Sunil Raviraj, Madhu Sasidharan, Harish Kareem, Ajith K. NairAbstractIntroductionIschemic reperfusion injury (IRI) is an important complication of liver transplant (LT). The donor risk index (DRI), which does not incorporate steatosis, includes several variables known to impact on allograft survival. The purpose of this study was to report on donor liver allograft steatosis and its association with severity of IRI.AimTo determine effect of type and grade of donor liver steato...
Source: Journal of Clinical and Experimental Hepatology - Category: Gastroenterology Source Type: research
Authors: Chew HC, Macdonald PS, Dhital KK Abstract Recent advancement in organ perfusion technology has led to increase clinical transplantation of marginal donor organs and allow for distant procurement of cardiac allograft beyond the time limitation of cold static storage. Ex-situ heart perfusion also provides essential nutrients to maintain cell integrity, thereby reducing the risk of ischaemic injury for functional preservation and provides a platform to assess organ viability and feasibility, with the potential for pharmacotherapy to recover these hearts. Notably, the use of NMP has led to the first distant pr...
Source: Journal of Thoracic Disease - Category: Respiratory Medicine Tags: J Thorac Dis Source Type: research
Conclusions: HMP was associated with a reduced incidence of EAD and biliary complications, as well as an increased 1-year graft survival, but it was not associated with the incidence of PNF, vascular complications, and the length of hospital stay.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research
Authors: Yu YM, Ni QQ, Wang ZJ, Chen ML, Zhang LJ Abstract Kidney transplantation is the treatment of choice for patients with end-stage renal disease, as it extends survival and increases quality of life in these patients. However, chronic allograft injury continues to be a major problem, and leads to eventual graft loss. Early detection of allograft injury is essential for guiding appropriate intervention to delay or prevent irreversible damage. Several advanced MRI techniques can offer some important information regarding functional changes such as perfusion, diffusion, structural complexity, as well as oxygenat...
Source: Korean Journal of Radiology - Category: Radiology Tags: Korean J Radiol Source Type: research
27Aim: To assess the value of perfusion and function parameters of dynamic renogram scintigraphy (RS) compared to renal biopsy (RB) and ultrasonography (US) in assessment of renal allograft dysfunction. Material and Methods: We studies 70 consecutive renal transplant patients who had post transplant RS, RB and US within 0) had higher mean HS compared to those with normal PS (2.77±0.9 vs 1.83±1.29; p0) had tendency to higher mean HS (2.58±0.73 vs 1.77±1.29; p2 were associated with older graft age (27.5±50.3 vs 0.45±0.55 months; p=0.011). Cutoff values of PS0 was best to predict reje...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: General Clinical Specialities: Renal/Hypertension Source Type: research
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