Institutional members access full text with Ovid®

Share this article on:

Ex Situ Perfusion of Human Limb Allografts for 24 Hours

Werner, Nicole L. MD, MS; Alghanem, Fares BS; Rakestraw, Stephanie L.; Sarver, Dylan C. BS; Nicely, Bruce RN, MSN; Pietroski, Richard E. MS; Lange, Paul MD; Rudich, Steven M. MD, PhD; Mendias, Christopher L. PhD; Rojas-Pena, Alvaro MD; Magee, John C. MD; Bartlett, Robert H. MD; Ozer, Kagan MD

doi: 10.1097/TP.0000000000001500
Original Clinical Science—General

Background Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance after procurement. In bilateral hand transplantations, this demands a 2 team approach and expedited transfer of the allograft, limiting the recovery to a small geographic area. Ex situ perfusion may be an alternative allograft preservation method to extend allograft survival time. This is a short report of 5 human limbs maintained for 24 hours with ex situ perfusion.

Methods Upper limbs were procured from brain-dead organ donors. Following recovery, the brachial artery was cannulated and flushed with 10 000 U of heparin. The limb was then attached to a custom-made, near-normothermic (30-33°C) ex situ perfusion system composed of a pump, reservoir, and oxygenator. Perfusate was plasma-based with a hemoglobin concentration of 4 to 6 g/dL.

Results Average warm ischemia time was 76 minutes. Perfusion was maintained at an average systolic pressure of 93 ± 2 mm Hg, flow 310 ± 20 mL/min, and vascular resistance 153 ± 16 mm Hg/L per minute. Average oxygen consumption was 1.1 ± 0.2 mL/kg per minute. Neuromuscular electrical stimulation continually displayed contraction until the end of perfusion, and histology showed no myocyte injury.

Conclusions Human limb allografts appeared viable after 24 hours of near-normothermic ex situ perfusion. Although these results are early and need validation with transplantation, this technology has promise for extending allograft storage times.

Five human limbs were maintained for 24 hours with near-normothermic (30-33°C) ex situ perfusion system composed of a pump, reservoir, and oxygenator to extend allograft survival time. The allografts appeared viable after 24 hours of near-normothermic ex situ perfusion. Supplemental digital content is available in the text.

1 Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.

2 Department of Orthopedic Surgery, The University of Michigan Health System, Ann Arbor, MI.

3 Gift of Life of Michigan, Ann Arbor, MI.

4 Lung Bioengineering United Therapeutics Corporation, Silver Spring, MD.

5 Section of Transplant Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.

Received 18 April 2016. Revision received 21 August 2016.

Accepted 31 August 2016.

R.E.P. is a board member, Arbor Research Collaborative for Health, Ann Arbor, Michigan Board member, United Network for Organ Sharing, Richmond, Virginia. President, Lung Bioengineering, United Therapeutics Corporation, Silver Spring, MD. A.R.-P., consultant for Terumo Cardiovascular Group. R.H.B., Financial interest in MC3, a bioengineering company that supplied a peristaltic pump for this research, which is not commercially available.

Institutional funds from the Department of Transplant Surgery, University of Michigan supported this work.

N.L.W. participated in project design, data acquisition, data analysis, data interpretation, drafted the article, and approval of article version to be published. F.A. participated in project design, data acquisition, data analysis, data interpretation, critical revision of the article, and approval of article version to be published. S.L.R. participated in data acquisition, critical revision of the article, and approval of article version to be published. D.C.S. participated in data analysis, critical revision of the article, and approval of article version to be published B.N. participated in project design, critical revision of the article, and approval of article version to be published. R.E.P. participated in project design, critical revision of the article, and approval of article version to be published. P.L. participated in project design, critical revision of the article, and approval of article version to be published. S.M.R. participated in project design, critical revision of the article, and approval of article version to be published. C.L.M. participated in data analysis, critical revision of the article, and approval of article version to be published. A.R.-P. participated in project design, data acquisition, data analysis, data interpretation, critical revision of the article, and approval of article version to be published. J.C.M. participated in project design, data interpretation, critical revision of the article, and approval of article version to be published. R.H.B. participated in project design, data interpretation, critical revision of the article, and approval of article version to be published. K.O. participated in project design, data acquisition, data analysis, data interpretation, drafted the article, and approval of article version to be published.

The authors declare no conflicts of interest.

Correspondence: Kagan Ozer, MD, Department of Orthopedic Surgery, University of Michigan Hospitals, 2098 South Main St. Ann Arbor, MI 48103. (kozer@umich.edu).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.