Ex Situ Perfusion of Human Limb Allografts for 24 Hours.

Background: Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance following 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 000U of heparin. The limb was then attached to a custom-made, near-normothermic (30-33[degrees]C) ex situ perfusion system composed of a pump, reservoir, and oxygenator. Perfusate was plasma-based with a hemoglobin concentration of 4-6 g/dL. Results: Average warm ischemia time was 76 minutes. Perfusion was maintained at an average systolic pressure of 93+/-2 mmHg, flow 310+/-20 mL/min, and vascular resistance 153+/-16 mmHg/L/min. Average oxygen consumption was 1.1+/-0.2 mL/kg/min. 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. While these results are early and need validation with transplantation, this technology has promise for extending allograft storage times. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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