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Effect of Subnormothermic Machine Perfusion on the Preservation of Vascularized Composite Allografts After Prolonged Warm Ischemia.

Authors :
Charlès L
Filz von Reiterdank I
Lancia HH
Shamlou AA
Berkane Y
Rosales I
Mink van der Molen AB
Coert JH
Cetrulo CL Jr
Lellouch AG
Uygun K
Source :
Transplantation [Transplantation] 2024 Nov 01; Vol. 108 (11), pp. 2222-2232. Date of Electronic Publication: 2024 Oct 22.
Publication Year :
2024

Abstract

Background: Warm ischemia time (WIT) and ischemia-reperfusion injury are limiting factors for vascularized composite allograft (VCA) transplantation. Subnormothermic machine perfusion (SNMP) has demonstrated the potential to extend WIT in organ transplantation. This study evaluates the effect of SNMP on VCA viability after prolonged WIT.<br />Methods: Rat hindlimbs underwent WIT for 30, 45, 60, 120, 150, or 210 min, followed by 3-h SNMP. Monitoring of perfusion parameters and outflow determined the maximum WIT compatible with limb viability after SNMP. Thereafter, 2 groups were assessed: a control group with inbred transplantation (Txp) after 120 min of WIT and an experimental group that underwent WIT + SNMP + Txp. Graft appearance, blood gas, cytokine levels, and histology were assessed for 21 d.<br />Results: Based on potassium levels, the limit of WIT compatible with limb viability after SNMP is 120 min. Before this limit, SNMP reduces potassium and lactate levels of WIT grafts to the same level as fresh grafts. In vivo, the control group presented 80% graft necrosis, whereas the experimental group showed no necrosis, had better healing ( P  = 0.0004), and reduced histological muscle injury ( P  = 0.012). Results of blood analysis revealed lower lactate, potassium levels, and calcium levels ( P  = 0.048) in the experimental group. Both groups presented an increase in interleukin (IL)-10 and IL-1b/IL-1F2 with a return to baseline after 7 to 14 d.<br />Conclusions: Our study establishes the limit of WIT compatible with VCA viability and demonstrates the effectiveness of SNMP in restoring a graft after WIT ex vivo and in vivo, locally and systemically.<br />Competing Interests: The authors declare no conflicts of interest.<br /> (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Details

Language :
English
ISSN :
1534-6080
Volume :
108
Issue :
11
Database :
MEDLINE
Journal :
Transplantation
Publication Type :
Academic Journal
Accession number :
38722685
Full Text :
https://doi.org/10.1097/TP.0000000000005035