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Weight Gain as a Criterion for Discontinuation of Ex Vivo Normothermic Limb Perfusion (EVNLP)
Abigail Meyers, BS1; Sonia Pandey, MD1; Payam Sadeghi, MD1; Varun Kopparthy, PhD1; Thomas Xia, BS1; Henri Brunengraber, PhD2; Srinivasan Dasarathy, MD3; Antonio Rampazzo, MD, PhD1; Bahar Bassiri Gharb, MD, PhD1
1. Cleveland Clinic Department of Plastic Surgery, 2. Case Western Reserve University, 3. Cleveland
2021-01-31
Presenter: Abigail Meyers, BS
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 majority of writing and revision in preparation of the abstract was carried out by the first author. They were also involved in the study design, acquisition of data, analysis, and interpretation of data.
Director Name: Bahar Bassiri Gharb
Author Category: Medical Student
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Purpose:
The aim of this study was to evaluate weight gain as a clinical indicator of injury during EVNLP.
Methods:
Mean arterial pressure (MAP), oxygen uptake rate (OUR), limb weight, contractility, perfusate potassium, lactate, creatine kinase, and muscle injury scores (MIS) during EVNLP of 8 porcine forelimbs were analyzed. All parameters were recorded at timepoints when 2%, 5%, 10%, and 20% limb weight gain occurred. Student t-tests or ANOVA, followed by Tukey post hoc pairwise comparison, were performed. Pearson's correlation assessed relationships between parameters.
Results:
Limbs reached the established weight gain levels at an average of 13+-5, 15+-5, 16+-5, 19+-4 hours, respectively. There was a positive correlation between weight gain and MAP (ρ=0.63, p<0.05), MIS (ρ=0.92, p<0.05), potassium (ρ=0.67, p<0.05), and lactate (ρ=0.63, p<0.05). Contractility was inversely correlated with weight gain (ρ=-0.71, p<0.05). There was a strong inverse relationship between contractility and both potassium (ρ=-0.93, p<0.05) and MIS (ρ=-0.96, p<0.05).
MIS significantly worsened by 5% weight gain (p<0.05). The MIS in cold stored controls at 6 hours was comparable to perfused limbs at the 5% weight gain (15 hours, p=0.096), but significantly better than that of perfused limbs at 20% weight gain (19 hours, p<0.05). MAP was significantly higher at 20% weight gain compared to both 5% and 2% (all p<0.05).
Conclusions:
At 5% weight gain, MIS were comparable to controls at 6 hours cold ischemia. Five percent weight gain is an early indicator of limb muscle injury and may serve as a standard for perfusion termination.
