Composite Vascularized Allograft Machine Preservation: State of the Art

AbstractPurpose of ReviewIn this review, we aim to introduce the concept of machine perfusion of vascularized composite allografts (VCAs). We briefly discuss the basic elements of the circuit design, role of the temperature during the perfusion, types of perfusate, and future trends in this field.Recent FindingsSeveral large animal models have demonstrated the efficacy of machine perfusion over static cold storage. While the maximum allowable ischemia time in VCA is 4 –6 h with cold storage method, promising results have been achieved in extended preservation times up to 24 h in machine perfusion technique.SummaryCurrent evidence shows that machine perfusion of VCA can overcome the limitations of static cold storage technique and not only can be considered as a preservation but also as a diagnostic and therapeutic method for the practice of replantation/transplantation.
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research

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ConclusionThis animal study demonstrates the feasibility of using this novel technique for resuscitation and precardiectomy evaluation of donated after circulatory death hearts. For those donor hearts without adequate function, an LVAD can be safely implanted as a “bail‐out” option. The limitations of this technique are the patient population to which it can be applied (only those patients eligible and consented for LVAD).
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ORIGINAL ARTICLE Source Type: research
Introduction: As bile acids(BAs), molecules affecting motility and immunity in the gut, also promote CLAD when aspirated, we hypothesized their involvement in airway immunity and contractility. BAs and airway infections in post-Tx bronchial washings (BWs) were monitored. We investigated distal airway kinetics (in vitro)to BAs and their role in pulmonary function (in vivo).Methods: BW(238) from 111 lung-Tx pts were tested for BAs (LC-MS) and infections. Murine and human precision-cut lung slices were perfused with 30µM BAs and 300 nM of acetylcholine(ACh): airway lumen area(LA) analyzed with video-phase contrast micro...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Transplantation Source Type: research
Conclusions We present a quick, simple, and affordable method to decellularize a muscle flap through the vascular network. Our proposed method is efficient and can be completed in a significantly shorter time when compared with other methods. It is also safe and does not affect integrity of tissue, and this is essential for a reliable recellularization.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Transplantation Surgery and Research Source Type: research
We describe a case of successfully ex vivo treated and transplanted human lung allografts.MethodsDonor human lungs were assessed using ex vivo, our trouble shooting protocol allowed safe recovery.ResultsWe successfully implanted our ex vivo treated organs.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: NEW TECHNOLOGIES Source Type: research
Conclusions: Assessment of flavin, a marker of mitochondrial complex I injury, in the perfusate provides a fast prediction of liver graft function and loss during ex situ MP before implantation. This finding may have high clinical relevance, as liver grafts from extended DBD or DCD donors carry considerable risks for recipients. On-line estimation of outcome before implantation would therefore substantially increase safe utilization of liver grafts.
Source: Annals of Surgery - Category: Surgery Tags: ESA PAPERS Source Type: research
Limited donor lung availability and prolonged wait times remain substantial barriers to lung transplant. According to the Scientific Registry of Transplant Recipients, 11% of patients were removed from the wait-list in 2017 because of death or clinical deterioration and 40% of patients waited longer than 1 year before transplant. Ex vivo lung perfusion (EVLP) provides the opportunity to expand the donor pool, but despite encouraging early posttransplant outcomes, the long-term effect of EVLP remains unclear. In this issue of JAMA Surgery, Divithotawela et al present 10-year outcomes of the Toronto Lung Transplant Group &rs...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
In this study, we investigated the long-term effects of the HESP on skeletal muscle metabolism, structure, and force generation and compared it with the current standard of preservation. Methods. Forty male Lewis rats (250 ± 25 g) were divided into 5 groups, including naive control, sciatic nerve transection or repair, immediate transplantation, SCS, and HESP. For the SCS group, limbs were preserved at 4°C for 6 hours. In the HESP group, limbs were continuously perfused with oxygenated histidine-tryptophan-ketoglutarate (HTK) solution at 10–15°C for 6 hours. Hemodynamic and biochemical parame...
Source: Transplantation - Category: Transplant Surgery Tags: Original Basic Science–General Source Type: research
This study shows that quantitative perfusion of kidney transplants can be evaluated safely during kidney transplantation. DGF being defined as one or more dialyses after kidney transplantation can only be detected postoperatively, however, it may be predicted intraoperatively. PMID: 31559620 [PubMed - as supplied by publisher]
Source: Zentralblatt fur Chirurgie - Category: Surgery Authors: Tags: Zentralbl Chir Source Type: research
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
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