title: The Effect of Ex Situ Perfusion in a Swine Limb Vascularized Composite Tissue Allograft on Survival up to 24 Hours.
abstract: OBJECTIVE
  To test the potential for the ex situ limb perfusion system to prolong limb allograft survival up to 24 hours.
  
  
  METHODS
  We used 20 swine for the study. In group 1 (control), 4 limbs were perfused with heparin solution and preserved at 4°C for 6 hours. In group 2, 4 limbs were perfused with autologous blood at 27°C to 32°C for 24 hours. In both groups, limbs were transplanted orthotopically to recipients and monitored for 12 hours. In addition to perfusion parameters, we recorded perfusate gases and electrolytes (pH, pCO2, pO2, O2 saturation, Na, K, Cl, Ca, HCO3, glucose, and lactate) and obtained functional electrostimulation hourly throughout the experiment. Histology samples were obtained for TUNEL staining and single-muscle fiber contractility testing.
  
  
  RESULTS
  In both groups, hemodynamic variables of circulation remained stable throughout the experiment. Neuromuscular electrical stimulation remained intact until the end of reperfusion in group 2 vs no response in group 1. In group 2, a gradual increase in lactate levels during pump perfusion returned to normal after transplantation. Compared with the contralateral limb in group 2, single-muscle fiber contractility testing showed no significant difference at the end of the experiment.
  
  
  CONCLUSIONS
  We demonstrated extended limb survival up to 24 hours using normothermic pulsatile perfusion and autologous blood.
  
  
  CONCLUSIONS
  Successful prolongation of limb survival using ex situ perfusion methods provides with more time for revascularization of an extremity.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI. Electronic address: kozer@umich.edu.
authors.forename: Kagan
authors.initials: K
authors.lastname: Ozer
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rojas-Pena
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Mendias
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bryner
authors.affiliation: Wayne State University Medical School, Detroit, MI.
authors.forename: Cory
authors.initials: C
authors.lastname: Toomasian
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
mesh_terms: D064591:Allografts; D000671:Amputation, Surgical; D000818:Animals; D001706:Biopsy; D001804:Blood Transfusion, Autologous; D004558:Electric Stimulation; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005552:Forelimb / Q000098:blood supply / Q000637:transplantation*; D006085:Graft Survival; D006493:Heparin / Q000008:administration & dosage*; D006863:Hydrogen-Ion Concentration; D007537:Isometric Contraction; D019344:Lactic Acid / Q000097:blood; D023421:Models, Animal; D018485:Muscle Fibers, Skeletal / Q000473:pathology; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods*; D011188:Potassium / Q000097:blood; D012881:Skin Temperature; D013552:Swine; D019172:Transplantation Conditioning / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents; D019344:Lactic Acid; D006493:Heparin; D011188:Potassium
keywords: Ex situ; perfusion; reperfusion; swine; vascularized composite tissue allograft