Franka Messner1, Johanna Grahammer, Theresa Hautz, Gerald Brandacher, Stefan Schneeberger. 1. aCenter for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria bDepartment of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Abstract
PURPOSE OF REVIEW: Ischemia and reperfusion injury (IRI) in vascularized tissue allotransplantation (VCA) remain largely undefined. Because VCA is comprised of different tissues, the sensitivity towards IRI may not be uniform. We, herein, attempt to address mechanistic aspects of IRI in VCA and provide a summary on potential technologies and targets for amelioration or treatment of IRI in this novel field. RECENT FINDINGS: IRI results in a loosened architecture of musculature, hypertrophic, centrally located cell nuclei as well as a high degree of neovascularization. Mitochondria in muscle tissue show a high degree of degeneration after prolonged ischemia whereas the ultrastructure remains normal after short cold ischemia time (CIT). Muscle cell necrosis accompanied by a diffuse inflammatory infiltrate and vasculopathy of small vessels is observed after 30 h of CIT. Nerves revealed a high degree of separation and vacuolization of myelin lamellae because of Wallerian degeneration. Approaches to minimize IRI include use of novel preservation solutions, administration of antioxidative and anti-inflammatory molecules/drugs as well as the implementation of machine perfusion in the setting of VCA. SUMMARY: Hand and face transplantations are logistically challenging procedures. Optimal planning and a highly congruent and motivated team are key to keep ischemia times to a minimum. In addition to pharmacological approaches, machine perfusion seems promising to help circumvent logistic problems and expand the donor pool in VCA.
PURPOSE OF REVIEW: Ischemia and reperfusion injury (IRI) in vascularized tissue allotransplantation (VCA) remain largely undefined. Because VCA is comprised of different tissues, the sensitivity towards IRI may not be uniform. We, herein, attempt to address mechanistic aspects of IRI in VCA and provide a summary on potential technologies and targets for amelioration or treatment of IRI in this novel field. RECENT FINDINGS: IRI results in a loosened architecture of musculature, hypertrophic, centrally located cell nuclei as well as a high degree of neovascularization. Mitochondria in muscle tissue show a high degree of degeneration after prolonged ischemia whereas the ultrastructure remains normal after short cold ischemia time (CIT). Muscle cell necrosis accompanied by a diffuse inflammatory infiltrate and vasculopathy of small vessels is observed after 30 h of CIT. Nerves revealed a high degree of separation and vacuolization of myelin lamellae because of Wallerian degeneration. Approaches to minimize IRI include use of novel preservation solutions, administration of antioxidative and anti-inflammatory molecules/drugs as well as the implementation of machine perfusion in the setting of VCA. SUMMARY: Hand and face transplantations are logistically challenging procedures. Optimal planning and a highly congruent and motivated team are key to keep ischemia times to a minimum. In addition to pharmacological approaches, machine perfusion seems promising to help circumvent logistic problems and expand the donor pool in VCA.
Authors: Laura C Burlage; Shannon N Tessier; Joanna W Etra; Korkut Uygun; Gerald Brandacher Journal: Curr Opin Organ Transplant Date: 2018-10 Impact factor: 2.640
Authors: Maria Shvedova; Yana Anfinogenova; Elena N Atochina-Vasserman; Igor A Schepetkin; Dmitriy N Atochin Journal: Front Pharmacol Date: 2018-07-05 Impact factor: 5.810
Authors: C Anton Fries; Shari D Lawson; Lin C Wang; Kai V Slaughter; Praveen K Vemula; Ashish Dhayani; Nitin Joshi; Jeffrey M Karp; Rory F Rickard; Vijay S Gorantla; Michael R Davis Journal: PLoS One Date: 2019-01-24 Impact factor: 3.240