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Pendexter CA, Haque O, Mojoudi M, Maggipinto S, Goutard M, Baicu S, Lellouch AG, Markmann JF, Brandacher G, Yeh H, Tessier SN, Cetrulo C, Uygun K. Development of a rat forelimb vascularized composite allograft (VCA) perfusion protocol. PLoS One 2023; 18:e0266207. [PMID: 36652460 PMCID: PMC9847903 DOI: 10.1371/journal.pone.0266207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
Vascularized composite allografts (VCAs) refer to en bloc heterogenous tissue that is transplanted to restore form and function after amputation or tissue loss. Rat limb VCA has emerged as a robust translational model to study the pathophysiology of these transplants. However, these models have predominately focused on hindlimb VCAs which does not translate anatomically to upper extremity transplantation, whereas the majority of clinical VCAs are upper extremity and hand transplants. This work details our optimization of rat forelimb VCA procurement and sub-normothermic machine perfusion (SNMP) protocols, with results in comparison to hindlimb perfusion with the same perfusion modality. Results indicate that compared to hindlimbs, rat forelimbs on machine perfusion mandate lower flow rates and higher acceptable maximum pressures. Additionally, low-flow forelimbs have less cellular damage than high-flow forelimbs based on oxygen uptake, edema, potassium levels, and histology through 2 hours of machine perfusion. These results are expected to inform future upper extremity VCA preservation studies.
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Affiliation(s)
- Casie A. Pendexter
- Department Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
| | - Omar Haque
- Department Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Mohammadreza Mojoudi
- Department Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
| | - Sarah Maggipinto
- Department Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
| | - Marion Goutard
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Dept. Surgery, Center for Transplant Sciences, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France
| | - Simona Baicu
- Sylvatica Biotech Inc., North Charleston, South Carolina, United States of America
| | - Alexandre G. Lellouch
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Dept. Surgery, Center for Transplant Sciences, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France
- Department of Plastic, Reconstructive, and Aesthetic Surgery Groupe Almaviva Santé, Clinique de l’Alma, IAOPC, Paris, France
| | - James F. Markmann
- Harvard Medical School, Boston, Massachusetts, United States of America
- Dept. Surgery, Center for Transplant Sciences, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Gerald Brandacher
- Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Heidi Yeh
- Harvard Medical School, Boston, Massachusetts, United States of America
- Dept. Surgery, Center for Transplant Sciences, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Shannon N. Tessier
- Department Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
| | - Curtis Cetrulo
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Dept. Surgery, Center for Transplant Sciences, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Korkut Uygun
- Department Surgery, Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children, Boston, Massachusetts, United States of America
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Datta S, Fitzpatrick AM, Haykal S. Preservation solutions for attenuation of ischemia-reperfusion injury in vascularized composite allotransplantation. SAGE Open Med 2021; 9:20503121211034924. [PMID: 34367640 PMCID: PMC8312154 DOI: 10.1177/20503121211034924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/07/2021] [Indexed: 01/21/2023] Open
Abstract
Vascularized composite allotransplantation represents the final level of the reconstructive ladder, offering treatment options for severe tissue loss and functional deficiencies. Vascularized composite allotransplantation is particularly susceptible to ischemia–reperfusion injury and requires preservation techniques when subjected to extended storage times prior to transplantation. While static cold storage functions to reduce ischemic damage and is widely employed in clinical settings, there exists no consensus on the ideal preservation solution for vascularized composite allotransplantation. This review aims to highlight current clinical and experimental advances in preservation solution development and their critical role in attenuating ischemia–reperfusion injury in the context of vascularized composite allotransplantation.
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Affiliation(s)
- Shaishav Datta
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Aisling M Fitzpatrick
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Siba Haykal
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.,Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Long-term Effects of Hypothermic Ex Situ Perfusion on Skeletal Muscle Metabolism, Structure, and Force Generation After Transplantation. Transplantation 2019; 103:2105-2112. [PMID: 31205264 DOI: 10.1097/tp.0000000000002800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypothermic ex situ perfusion (HESP) systems are used to prolong allograft survival in solid organ transplantations and have been shown to be superior to static cold storage (SCS) methods. However, the effect of this preservation method on limb allograft survival and long-term function has not yet been tested. 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 parameters of perfusion were recorded throughout the experiment. At 12 weeks, electromyography and muscle force measurements (maximum twitch and tetanic forces) were obtained along with muscle samples for histology and metabolomics analysis. RESULTS Histology demonstrated 48% myocyte injury in the HESP group compared with 49% in immediate transplantation (P = 0.96) and 74% in the SCS groups (P < 0.05). The maximum twitch force measurement revealed a significantly higher force in the HESP group compared with the SCS group (P = 0.029). Essential amino acid levels of the gastrocnemius muscle did not reach significance, with the exception of higher proline levels in the HESP group. CONCLUSIONS HESP using HTK protects viability of the limb but fails to restore muscle force in the long term.
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