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Ex Vivo Normothermic Limb Perfusion Preserves Human Upper Extremities for Up to 50 hours
Majid Rezaei, Carlos Ordenana, Sayf Al-Deen Said, Vahe Fahradyan, Edoardo Dalla Pozza, Maria Madajka, Michael Annunziata, Francis Papay, Antonio Rampazzo, Bahar Bassiri Gharb
Microsurgery Laboratory
2019-02-11
Presenter: Majid Rezaei
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Bahar Bassiri Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Ischemia-reperfusion injury remains a major limiting factor for upper extremity replantation and allotransplantation. Ex Vivo Normothermic Limb Perfusion (EVNLP) is a novel approach to prolong organ viability by maintaining physiologic metabolism and avoiding deleterious effects of hypoxia and cooling. This study aimed to assess the effectiveness of EVNLP in preserving the viability and function of amputated human limbs.
Fourteen human upper extremities were procured. Seven were perfused using oxygenated colloid solution containing pRBCs at 38°C, until vascular resistance increased above 250mmHg.min/L. Control limbs were preserved at 4°C. Electrolytes were kept within physiologic range by perfusate exchanges. Viability was assessed by muscle contractility, tissue oxygen saturation, creatine kinase (CK) and myoglobin concentrations, indocyanine green (ICG) angiography, thermography, and histology.
Perfused limbs retained physiological parameters and function up to 50 hours (mean 40.3 ± 10.1 h) with a final weight change of -1.3% ±12.7%. The limbs displayed an initial high perfusion pressure (MAP 75.3±2.8 mmHg) and high resistance (240.1±29.6 mmHg.min/L) that decreased significantly after 7±4 hours and remained stable thereafter (MAP 73.5 ± 3 mmHg). One limb displayed compartment syndrome features after 6 hours, requiring fasciotomy. Muscle contraction was absent initially; but recovered gradually and became maximal at median 5±3.5 hours. Control group showed no contraction. Thermography and ICG angiography depicted uniform peripheral perfusion throughout the experiments.
EVNLP provides the opportunity to significantly prolong preservation time, assess viability of limbs, and to allow limb reconditioning prior to transplantation. EVNLP may have important future implications for limb preservation and ideal donor limb selection.
