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Efficacy of Ex Vivo Normothermic Limb Perfusion in Maintaining Cellular Viability and Muscle Function
Payam Sadeghi, Thomas Xia, Varun Kopparthy, Sonia Pandey, Antonio Rampazzo, Bahar Bassiri Gharb
Cleveland Clinic
2021-02-15
Presenter: Payam Sadeghi, MD
Affidavit:
Payam Sadeghi
Director Name: Bahar Bassiri Gharb
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Introduction- Ex vivo normothermic limb perfusion (EVNLP) is a novel preservation strategy that prolongs the viability of amputated limbs by supporting aerobic metabolism. The purpose of this study was to evaluate cell injury during EVNLP compared to standard cold storage.
Methods- Twenty human upper extremities were procured from organ donors following brain death. Ten were perfused with an oxygenated colloid solution at 38°C for 48 hours or until termination criteria were met. The contralateral limbs were preserved at 4°C. Limb viability was assessed through contractility testing, infrared thermography, and indocyanine green angiography.
Myocytes were classified as damaged if there was nuclei extravasation, disrupted cell membrane, or distinct fissures within the cytoplasm using Hematoxylin and Eosin staining.
Results- Limbs were perfused for 41.6ą9.4 hours. Contractility was observed for a median of 30.5 hours (range 16-40 hours) and maximum contractility was maintained for a median of 8 hours (range 1-15 hours). Final weight change was +0.4ą12.2% and 0ą0% in the EVNLP group and control group, respectively (p=0.00025). Thermography and ICG angiography demonstrated peripheral perfusion of the experimental limbs. Average MIS were 24.7ą13.0% and 44.3ą30.6% for the EVNLP and control groups, respectively (p=0.00879). In the EVNLP group, MIS did not significantly differ among time points 0, 12, 24, 36, and 48 hours (p=0.46). In the control group, MIS was significantly higher, 75.4% at endpoint (44.8ą4.8 hours) compared to time point 0, 31.1% (p=0.009).
Conclusion- EVNLP can halt the progression of myocyte injury for 41 hours and maintain normal muscle function beyond 24 hours.
