A Hyperbaric Warm Perfusion System Preserves Tissue Composites Ex vivo and Delays the Onset of Acute RejectionFunding This work was funded by the 59 MDW Office of Science and Technology of the U.S. Air Force and by the UK Ministry of Defense.
01 March 2018
18 June 2018
12 August 2018 (online)
Background Ischemia–reperfusion injury (IRI) precipitates acute rejection of vascularized composite allografts (VCA). Hyperbaric preservation of tissues ex vivo, between harvest and revascularization, may reduce IRI and mitigate acute rejection of VCA.
Methods A porcine heterotopic musculocutaneous gracilis flap model was used. In phase 1, control autografts (n = 5) were infused with University of Wisconsin Solution (UWS) and stored at 4°C for 3 hours. Intervention autografts (n = 5) were placed in a hyperbaric oxygen organ preservation system for 5 hours and infused with hyperoxygenated UWS at 20°C and 3 atm. Grafts were replanted into the animals' necks. In phase 2, similarly treated control (n = 8) and intervention grafts (n = 8) were allotransplanted into the necks of animals separated by a typed and standardized genetic mismatch. No systemic immunosuppression was given. Systemic markers of IRI, and clinical and histopathological assessments of necrosis and rejection were performed.
Results Autotransplanted tissue composites preserved in the hyperbaric chamber showed histopathological evidence of less muscle necrosis at 3 hours (p = 0.05). Despite a longer period of ischemia, no evidence was found of a difference in systemic markers of IRI following revascularization in these groups. Allotransplanted tissues supported ex vivo within the hyperbaric perfusion device experienced acute rejection significantly later than corresponding controls.
Conclusion Hyperbaric warm perfusion preserves musculocutaneous tissue composites ex vivo for longer than standard cold preservation in this model. This translates into a delay in acute rejection of allotransplanted tissue composites.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of Departments of the Air Force, the Army, the U.S. Department of Defense, or the UK Ministry of Defense.
This study was conducted under a protocol reviewed and approved by the Air Force Medical Service (AFMS), Wilford Hall Ambulatory Surgical Center (WHASC), Institutional Animal Care and Use Committee (IACUC), and the IACUC of the Tri-Service Research Laboratory, Fort Sam Houston, San Antonio, TX.
This study was conducted in the performance of Cooperative Research and Development Agreement number 10-333-WHMC-CRADA2 between Wilford Hall Ambulatory Surgical Center and Hyperbaric Oxygen Organ Preservation Systems.
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