AUTHOR=Muss Tessa E. , Drivas Eleni M. , Loftin Amanda H. , Guo Yinan , Zhang Yichuan , Lopez Christopher D. , Girard Alisa O. , Lake Isabel V. , Hassan Bashar , Kalsi Richa , Oh Byoung Chol , Brandacher Gerald 

TITLE=Ex-Vivo Perfusion of Limb Vascularized Composite Allotransplants: A Systematic Review of Published Protocols

JOURNAL=Transplant International

VOLUME=Volume 38 - 2025

YEAR=2025

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.14132

DOI=10.3389/ti.2025.14132

ISSN=1432-2277

ABSTRACT=Vascularized composite allotransplantation (VCA) has revolutionized restorative surgery of devastating injuries. Unfortunately, these grafts undergo significant injury during prolonged cold ischemia and subsequent reperfusion. Ex-vivo-machine-perfusion (EVMP) has shown significant promise in solid organ transplant, but study of its utility in VCA has been limited. A systematic review was conducted to identify preclinical publications investigating perfusion in limb VCAs. Articles published through June 2023 were screened. 29 articles met inclusion criteria, comprising 370 VCA limbs from swine, rats, canines, and humans. EVMP was conducted under normothermic (n=6), near-normothermic (n=11), sub-normothermic (n=3), or hypothermic (n=13) conditions. While each study used a unique perfusate recipe, most were based on a premade medium while many incorporated additives. The duration varied from 3 to over 24hours. Multiple studies showed improved or equivalent biomarkers, histology, and outcomes for normothermic or near-normothermic EVMP (n=4) and hypothermic EVMP (n=8) compared to static cold storage, suggesting that EVMP may be a superior storage method to SCS. Currently there is no definitive evidence regarding the optimal temperature, perfusate composition, or perfusion time. This review offers a summary of the current literature to serve as an accessible reference for the design of future protocols in this field.