ArticleThe British journal of surgery2021
Randomized preclinical study of machine perfusion in vascularized composite allografts.
Article in The British journal of surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Transplant international : official journal of the European Society for Organ Transplantation · 2025Pooled it
- A meta-analysis of perfusion parameters affecting weight gain in ex vivo perfusion.Artificial organs · 2025Pooled it
- 24-hourFrontiers in transplantation · 2026Article
- Ex-vivo limb perfusion in military and civilian medicine: inspired by ex-vivo organ perfusion, pioneered for traumatic limb amputation and peripheral nerve regeneration.Military Medical Research · 2025Article
- Successful Extension of Vascularized Composite Allograft Perfusion Cold Storage to 24 h in a Rat Hindlimb Transplant Model.Transplantation direct · 2024Article
- Design of a Multiparametric Perfusion Bioreactor System for Evaluating Sub-Normothermic Preservation of Rat Abdominal Wall Vascularized Composite Allografts.Bioengineering (Basel, Switzerland) · 2024Article
- Study on the preservation effects of the amputated forelimb by machine perfusion at physiological temperature.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2024Article
- Methods of ex vivo analysis of tissue status in vascularized composite allografts.Journal of translational medicine · 2023Review
- Real-Time Monitoring Using Multiplexed Multi-Electrode Bioelectrical Impedance Spectroscopy for the Stratification of Vascularized Composite Allografts: A Perspective on Predictive Analytics.Bioengineering (Basel, Switzerland) · 2023Article
- Continuous versus Pulsatile Flow in 24-Hour Vascularized Composite Allograft Machine Perfusion in Swine: A Pilot Study.The Journal of surgical research · 2023Article
- Review of machine perfusion studies in vascularized composite allotransplant preservation.Frontiers in transplantation · 2023Review
- Bionic Prostheses: The Emerging Alternative to Vascularised Composite Allotransplantation of the Limb.Frontiers in surgery · 2022Review
- Improving the ischemia-reperfusion injury in vascularized composite allotransplantation: Clinical experience and experimental implications.Frontiers in immunology · 2022Review
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAttempts to improve limb preservation for transplantation using ex vivo perfusion have yielded promising results. However, metabolic acidosis, aberrant perfusate biochemistry and significant perfusion-induced oedema are reported universally. Optimizing perfusion protocols is therefore essential for maintaining tissue health.
methodsA randomized, two-stage open preclinical trial design was used to determine the optimal temperature and mean arterial pressure for machine perfusion. Conditions compared were: normothermic machine perfusion at 70 mmHg (NMP-70); subnormothermic perfusion (28°C) at 70 mmHg; subnormothermic (28°C) perfusion at 50 mmHg; and hypothermic perfusion (10°C) at 30 mmHg. Following this, a head-to-head experiment was undertaken comparing the optimal machine perfusion with static cold storage. Paired bilateral limbs (10 in total) were randomized to either 8 h of static cold storage, or 2 h of static cold storage and 6 h of optimal machine perfusion. Both groups of limbs were then reperfused on a circuit primed with matched blood from unrelated donors for 4 h without immunosuppression.
resultsNMP-70 resulted in less tissue injury and stable perfusion biochemistry. Assessing reperfusion outcomes, static cold storage resulted in acidosis with increased lactate and a worsening electrolyte profile, necessitating bolus infusions of bicarbonate to prevent graft loss. Conversely, NMP-70 was associated with haemodynamic and biochemical stability. Histologically, on reperfusion with allogeneic whole blood, limbs subjected to static cold storage exhibited multifocal ischaemic injury and increased inflammation, which was absent with NMP-70. Static cold storage also resulted in significant oedema compared with NMP-70.
conclusionNormothermic perfusion resulted in superior graft preservation and less reperfusion injury compared with the current static cold storage protocol.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.