ABSTRACT
BACKGROUND: Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance after procurement. In bilateral hand transplantations, this demands a 2 team approach and expedited transfer of the allograft, limiting the recovery to a small geographic area. Ex situ perfusion may be an alternative allograft preservation method to extend allograft survival time. This is a short report of 5 human limbs maintained for 24 hours with ex situ perfusion. METHODS: Upper limbs were procured from brain-dead organ donors. Following recovery, the brachial artery was cannulated and flushed with 10 000 U of heparin. The limb was then attached to a custom-made, near-normothermic (30-33°C) ex situ perfusion system composed of a pump, reservoir, and oxygenator. Perfusate was plasma-based with a hemoglobin concentration of 4 to 6 g/dL. RESULTS: Average warm ischemia time was 76 minutes. Perfusion was maintained at an average systolic pressure of 93 ± 2 mm Hg, flow 310 ± 20 mL/min, and vascular resistance 153 ± 16 mm Hg/L per minute. Average oxygen consumption was 1.1 ± 0.2 mL/kg per minute. Neuromuscular electrical stimulation continually displayed contraction until the end of perfusion, and histology showed no myocyte injury. CONCLUSIONS: Human limb allografts appeared viable after 24 hours of near-normothermic ex situ perfusion. Although these results are early and need validation with transplantation, this technology has promise for extending allograft storage times.
Subject(s)
Composite Tissue Allografts/blood supply , Composite Tissue Allografts/transplantation , Organ Preservation/methods , Perfusion/methods , Upper Extremity/blood supply , Upper Extremity/surgery , Vascularized Composite Allotransplantation/methods , Adult , Aged , Biomarkers/blood , Brain Death , Composite Tissue Allografts/innervation , Electric Stimulation , Equipment Design , Female , Hemodynamics , Humans , Male , Middle Aged , Muscle Contraction , Organ Preservation/adverse effects , Organ Preservation/instrumentation , Oxygen Consumption , Perfusion/adverse effects , Perfusion/instrumentation , Reperfusion Injury/etiology , Reperfusion Injury/prevention & control , Time Factors , Tissue Donors , Tissue Survival , Upper Extremity/innervation , Vascularized Composite Allotransplantation/adverse effects , Warm IschemiaSubject(s)
Health Services for the Aged , Kidney Transplantation , Tissue Donors , Tissue and Organ Procurement , Adult , Age Factors , Aged , Biopsy , Europe , Humans , Kidney/pathology , Middle AgedABSTRACT
Previous measures of OPO performance based on population counts have been deemed inadequate, and the need for new methods has been widely accepted. This article explains recent developments in OPO performance evaluation methodology, including those developed by the SRTR. As a replacement for the previously established measure of OPO performance--donors per million population--using eligible deaths as a national metric has yielded promising results for understanding variations in donation rates among the donation service areas assigned to each OPO. A major improvement uses "notifiable deaths" as a denominator describing a standardized maximal pool of potential donors. Notifiable deaths are defined as in-hospital deaths among ages 70 years and under, excluding certain diagnosis codes related to infections, cancers, etc. A most proximal denominator for determining donation rates is "eligible deaths," which includes only those deaths meeting the criteria for organ donation upon initial assessment. Neither measure is based on the population of a geographic unit, but on restricted upper limits of deaths that could be potential donors in any one locale (e.g., hospital or OPO). The inherent strengths and weaknesses of metrics such as donors per eligible deaths, donors per notifiable deaths, and number of organs per donor are discussed in detail.
