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Tawa P, Goutard M, Andrews AR, de Vries RJ, Rosales IA, Yeh H, Uygun B, Randolph MA, Lellouch AG, Uygun K, Cetrulo CL. Continuous versus Pulsatile Flow in 24-Hour Vascularized Composite Allograft Machine Perfusion in Swine: A Pilot Study. J Surg Res 2023; 283:1145-1153. [PMID: 36915006 PMCID: PMC10867902 DOI: 10.1016/j.jss.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 10/12/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Multiple perfusion systems have been investigated on vascularized composite allografts, with various temperatures and different preservation solutions, most using continuous flow (CF). However, physiological flow is pulsatile and provides better outcomes in kidney and lung ex vivo perfusions. The objective of this pilot study is to compare pulsatile flow (PF) with CF in our 24-h subnormothermic machine perfusion protocol for swine hindlimbs. METHODS Partial hindlimbs were harvested from Yorkshire pigs and perfused with a modified Steen solution at 21°C for 24 h either with CF (n = 3) or with pulsatile flow (PF) at 60 beats/min (n = 3). Perfusion parameters, endothelial markers, and muscle biopsies were assessed at different timepoints. RESULTS Overall, lactate levels were significantly lower in the PF group (P = 0.001). Glucose uptake and potassium concentration were similar in both groups throughout perfusion. Total nitric oxide levels were significantly higher in the PF group throughout perfusion (P = 0.032). Nitric oxide/endothelin-1 ratio also tends to be higher in the PF group, reflecting a potentially better vasoconductivity with PF, although not reaching statistical significance (P = 0.095). Arterial resistances were higher in the PF group (P < 0.001). Histological assessment did not show significant difference in muscular injury between the two groups. Weight increased quicker in the CF group but reached similar values with the PF after 24 h. CONCLUSIONS This pilot study suggests that PF may provide superior preservation of vascularized composite allografts when perfused for 24 h at subnormothermic temperatures, with potential improvement in endothelial function and decreased ischemic injury.
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Affiliation(s)
- Pierre Tawa
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts; Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France
| | - Marion Goutard
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts; Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France
| | - Alec R Andrews
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts
| | - Reinier J de Vries
- Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts; Department of Surgery, Amsterdam University Medical Centers - Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ivy A Rosales
- Harvard Medical School, Boston, Massachusetts; Immunopathology Research Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts
| | - Heidi Yeh
- Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Basak Uygun
- Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts; Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark A Randolph
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts
| | - Alexandre G Lellouch
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts; Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes, Paris, France
| | - Korkut Uygun
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts; Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Curtis L Cetrulo
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Shriners Hospital for Children, Boston, Massachusetts.
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Higashi Y, Homma J, Sekine H, Yago H, Kobayashi E, Shimizu T. External pressure dynamics promote kidney viability and perfusate filtration during ex vivo kidney perfusion. Sci Rep 2022; 12:21564. [PMID: 36513748 PMCID: PMC9747902 DOI: 10.1038/s41598-022-26147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Normothermic machine perfusion (NMP) has not yet been established as a technique for preserving organs for a day. A key contributing factor to the same is that the perfusing solutions cannot circulate continuously and evenly in the organs. Here, we conceived a method of applying intermittent air pressure from outside the organ to assist its circulatory distribution during perfusion. We used a perfusion culture system while applying external pressure to culture rat kidneys and compared the circulatory distribution in the kidneys, changes in tissue morphology due to injury, and perfusate filtration. The intermittent pressurization (IMP) (-) group showed markedly poorer circulation on the upper side compared with that in the lower side, alongside histological damage. On the other hand, the IMP (+) group showed improved circulation in the upper side and had lesser histological damage. Furthermore, the IMP (+) group maintained the ability to filter perfusate for 24 h. In transplantation medicine and regenerative medicine research, this method has the potential to contribute to more efficient organ preservation and more functional tissue regeneration in the future.
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Affiliation(s)
- Yuhei Higashi
- grid.410818.40000 0001 0720 6587Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan ,Tokaihit Co., Ltd., Shizuoka, Japan
| | - Jun Homma
- grid.410818.40000 0001 0720 6587Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Hidekazu Sekine
- grid.410818.40000 0001 0720 6587Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Hiroki Yago
- grid.410818.40000 0001 0720 6587Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
| | - Eiji Kobayashi
- grid.411898.d0000 0001 0661 2073Department of Kidney Regenerative Medicine, Industry-Academia Collaborative Department, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsuya Shimizu
- grid.410818.40000 0001 0720 6587Institute of Advanced Biomedical Engineering and Science, TWIns, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan
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The Impact of Nutritional Supplementation on Donor Kidneys During Oxygenated Ex Vivo Subnormothermic Preservation. Transplant Direct 2022; 8:e1382. [PMID: 36204184 PMCID: PMC9529041 DOI: 10.1097/txd.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022] Open
Abstract
Evidence suggests that nutritional supplementation during normothermic ex vivo perfusion improves organ preservation. However, it is unclear whether the same benefit is observed during room temperature (subnormothermic) oxygenated perfusion. In this study, we tested the impact of providing complete nutrition during subnormothermic perfusion on kidney outcomes.
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