Summary
Background
Passenger leucocytes and inflammatory debris transferred from the donor limb to the
recipient can induce allorecognition, which activates the host immune response. This
is the first study to evaluate whether the transfer of this inflammatory burden can
be reduced via post-preservation flush prior to revascularisation, and whether this
is influenced by ischaemia.
Methods
Bilateral forelimbs from the same pig were procured and infused with preservation
flush and stored on ice. Each limb from the same pig underwent a post-preservation
intravascular flush with isotonic solution at either 2 or 6 h. Venous effluent underwent
flow cytometry to phenotype leucocyte populations, with additional quantification
of cytokines and cell-free DNA.
Results
We identified large populations of viable leucocytes in the flush effluent (8.65 × 108 ± 3.10 × 108 cells at 2 h and 1.02 × 109 ± 2.63 × 108 at 6 h). This comprised T cells, B cells, NK cells and monocytes. Post-preservation
flush yielded significant concentrations of pro-inflammatory cytokines including IL-6,
IL-18, GM-CSF, IL-1β, IL1α and CXCL-8 and mitochondrial DNA. The regulatory cytokine,
IL-10 was undetectable.
Conclusions
This study supports the finding that a post-preservation flush removes leucocytes
and inflammatory components that are responsible for direct presentation. This study
also gives an indication of how ischaemia impacts on the inflammatory burden transferred
to the recipient upon reperfusion.
Keywords
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Article info
Publication history
Published online: November 24, 2017
Accepted:
November 7,
2017
Received:
April 19,
2017
Footnotes
Authored by a member of BAPRAS
Identification
Copyright
© 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on “Ex-vivo flush of the limb allograft reduces inflammatory burden prior to transplantation”Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 71Issue 2
- PreviewAlthough vascularised composite allotransplantation (VCA) is increasingly being performed and for a widening range of indications – some now consider transplantation to be the standard of care for mid-forearm amputations2 – more widespread application is limited by the risks associated with lifelong immunosuppression.
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