Novel Oxygen Carrier Technology to Prolong Graft Preservation, Minimize Ischemia-Reperfusion Injury, and Optimize Neuroprotection in Composite Allografts
Abstract
Organ transplantation is a definitive intervention for the management of solid organ failure, most notably heart, kidney, liver, and lung. The success of solid organ transplantation has led several clinical teams to apply this technology to patients with non-salvageable injuries such as severe burns or limb amputation, and is now known as a vascularized composite allotransplantation (VCA). Currently, most reconstructive procedures for major tissue defects due to trauma, tumor removal, or congenital anomalies are performed with autologous (the patient’s own) tissue. However, there are severe defects that cannot be reconstructed this way. In complex injuries or defects not amenable to conventional reconstruction, VCA could potentially achieve near normal tissue restoration and improved functional and esthetic outcomes. VCA refers to the transplantation of multiple tissues such as muscle, bone, nerve, and skin, as a functional unit (e.g., a hand or face) from a deceased donor to a recipient with a severe injury. These grafts serve as potential replacements for traumatic tissue losses such as limb loss from explosive devices, accidents with farm machinery, burns or other major injuries. VCAs tolerate only limited time without blood supply (cannot be processed or stored), require rapid re-establishment of blood flow, and donor-recipient matching, thus sharing identical issues with transplanted organs (governed by UNOS [United Network for Organ Sharing] regulations) rather than tissue (for which none of these stipulations apply) and thus have unique characteristics for regulatory purposes. During the past decade, over 200 patients have received a VCA worldwide. In VCA, unlike organs, matching of skin color, tone, gender, and size of the graft in addition to blood type between donor and recipient, further limits suitable donors. Also, subsequent efforts to streamline allocation and improve recipient matching may indeed mandate donor VCA sharing across wider geographic distances -- increasing ischemia times. Thus, any measures to increase the donor pool will significantly impact not only solid organs but also more importantly, VCA. Novel technologies that supply oxygen to the tissues of VCA during their transportation across distances can protect the nerve and muscle components and possibly help improve functional results of these transplants.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1710524
Entities
People
- Vijay S Gorantla
Organizations
- United States Army
- Wake Forest School of Medicine