<< Back to the abstract archive
Limb Transplantation Following Ex Vivo Normothermic Perfusion In An Orthotopic Forelimb Swine Transplantation Model
Sayf Said, MD, Carlos X. Ordenana, MD, Majid Rezaei, DDSMs, Fahradyan Vahe, MD, Lynn Orfahli, BM, Brian Figueroa, MD, William Baldwin, MD PhD, Francis Papay, MD, Antonio Rampazzo, MD PhD, Bahar Bassiri Gharb, MD PhD
Cleveland Clinic
2020-02-11
Presenter: Carlos Ordenana
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. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Bassiri Bahar Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
PURPOSE:
Ischemia-reperfusion injury remains a major limiting factor for replantation and transplantation. Ex-vivo normothermic limb perfusion (EVNLP) has been proven to preserve viability and function of amputated limbs longer than cold storage.
METHODS:
Eight Yucatan miniature pigs were used. Forelimbs were amputated at mid-humeral level and preserved with EVNLP. Perfusate electrolytes and gases, tissue oxygen saturation, limb muscle contraction and surface temperature were assessed hourly. The humerus was fixed with a single plate; microsurgical anastomosis of the brachial artery, cephalic vein, and repair of radial, ulnar, and median nerves were performed. Tendons of the biceps and triceps were repaired with a pulvertaft weave technique. Systemic immunosuppression included: antithymoglobulin (induction), cyclosporine, mycophenolate mofetil and methylprednisolone. The endpoint was 90 days.
RESULTS:
Warm ischemia time was 20.6±9 minutes before EVNLP and 2.2±0.25 hours after. EVNLP lasted 4.3±0.52 hours. PO2, pH and Lactate where 557±72mmHg, 7.5±0.1, 5.6±0.9mmol/L respectively. Muscle contractions at the end of EVNLP were 4/5. All forelimbs were successfully transplanted. Animals 3 and 4 lost IV access on POD 54 and 64 respectively and were transitioned to PO medications. Animal 1 and 3 developed acute rejection on POD 4 and 57 and were euthanized on POD 6 and 60 respectively. The remaining animals' incisions healed and initial edema resolved by day 14. Animals 2, 3 and 4 showed bone healing and consolidation with the presence of bony callus on CT scans.
CONCLUSION:
Extremity transplantation can be successfully performed following EVNLP. EVNLP does not increase risk of vascular or infectious complications.
