In this review, we discuss novel strategies that allow for extended preservation of vascularized composite allografts and their potential future clinical implications for the field of vascularized composite allotransplantation (VCA).
The current gold standard in tissue preservation – static cold preservation on ice – is insufficient to preserve VCA grafts for more than a few hours. Advancements in the field of VCA regarding matching and allocation, desensitization, and potential tolerance induction are all within reasonable reach to achieve; these are, however, constrained by limited preservation time of VCA grafts. Although machine perfusion holds many advantages over static cold preservation, it currently does not elongate the preservation time. More extreme preservation techniques, such as cryopreservation approaches, are, however, specifically difficult to apply to composite tissues as the susceptibility to ischemia and cryoprotectant agents varies greatly by tissue type.
In the current scope of extended preservation protocols, high subzero approaches of VCA grafts will be particularly critical enabling technologies for the implementation of tolerance protocols clinically. Ultimately, advances in both preservation techniques and tolerance induction have the potential to transform the field of VCA and eventually lead to broad applications in reconstructive transplantation.
aDepartment of Surgery, Center for Engineering in Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
bDepartment of Surgery, Section Hepato-Pancreato-Bilibary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
cShriners Hospitals for Children – Boston, Boston, Massachusetts
dDepartment of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Correspondence to Korkut Uygun, PhD, Department of Surgery, Center for Engineering in Medicine, Harvard Medical School, Massachusetts General Hospital, 51 Blossom St, Boston, MA 02114, USA. Fax: +1 617 573 9471; e-mail: firstname.lastname@example.org