Multiorgan Harvesting Research Articles

The Analysis of Bacterial Results in the Kidney Perfusion Fluid and Bone Allografts in Human Multiorgan Donors.

In 19 young human multiorgan donors, we simultaneously analyzed the bacterial contamination of the kidney perfusion fluid and all retrieved bone allografts. Donor exclusion criteria were done according to the American and European Association of Tissue Banks excluding all patients with perforating wounds. The kidney perfusate revealed a contamination in 17 of 19 (89.5%) donors. Allograft testing demonstrated positive bacterial growth in 34 of 76 allografts (44.7%). Microorganisms originated from the normal skin flora and could be related to contamination during the harvesting procedure. In 5 cases we cultured identical bacterial subspecies in both cultures as a possible sign for systemic bacterial spreading during the multiorgan harvesting procedure.

Below-Knee Bypass Using Fresh Arterial Allografts for Limb Salvage: Early Results

The purpose of this study was to evaluate early results of below-knee bypass using fresh arterial allografts as arterial substitutes for limb salvage. From April 1991 to September 1993, we performed 28 below-knee bypass procedures using fresh arterial allografts in patients without a suitable autologous vein. Allografts were obtained by multiorgan harvesting from brain-dead subjects and preserved at 4 degrees C. Histologic examination of grafts was carried out. Secondary patency at 2 years calculated using the Kaplan-Meier method was 64% (confidence interval [CI] 45%-79%). No signs of graft deterioration or rejection were noted. These preliminary results are encouraging but long-term assessment is needed before expanding the range of application.

Cryopreserved Arterial Allografts for Limb Salvage in the Absence of Suitable Saphenous Vein: Two-Year Results in 20 Cases

From January 1992 to November 1992, 20 cryopreserved arterial allografts were used as below-knee bypasses for repeated limb salvage in 18 patients lacking saphenous vein grafts. Arteries were obtained during multiorgan harvesting. A scheduled program of cryopreservation with 15% dimethylsulfoxide was used. Mean storage period was 37 days. All cases were matched for blood group compatibility. Patency was checked at 10 and 90 days and twice a year thereafter. Conventional arteriography was routinely performed 3 months postoperatively. Average follow-up was 26.8 months for the 18 patients and 20.8 months for the 20 bypass grafts. No patients were lost to follow-up. Aneurysmal dilation developed in one graft, which was replaced by another homograft. During follow-up 10 grafts occluded: five once, four twice, and one four times. These 10 grafts underwent a total of 16 reinterventions. Thrombectomy with angioplasty was performed 15 times and graft replacement once because of proximal and distal arterial deterioration. Primary actuarial patency was 68% at 1 year and 42% at 2 years. Secondary actuarial patency was 89% at 1 year and 72% at 2 years. Preliminary results of cryopreserved arterial allografts for repeated limb salvage in the absence of available saphenous veins are encouraging. Further studies are needed to determine the long-term deterioration rate of cryopreserved arterial allografts.

Cryopreserved Arterial Homografts: Preliminary Study

The use of arterial or venous allografts for vascular reconstruction was first reported in 1951, but long-term results have been disappointing. Rejection and inappropriate methods of preservation are the main reasons for failure. A successful solution to this problem could be achieved by programmed cryopreservation with cryoprotectant. Our study had two aims: to define the biomechanical properties of cryopreserved arterial allografts and to study their histologic appearance. Arteries were removed as part of a protocol for multiorgan harvesting for transplantation. Cryopreservation was performed within the first 24 hours after harvesting. Programmed cryopreservation with 15% dimethyl sulfoxide (cryoprotectant) was used. Mechanical testing was done immediately after thawing. Two groups were tested: a control group of fresh aortas and a group of cryopreserved aortas. Axial and circumferential strips were tested. High strain modulus and stress and strain characteristics were calculated for each strip. There was no statistically significant difference between the mechanical properties of fresh and cryopreserved human descending thoracic aortas. Biochemical tests were performed in the preservative solution at 1 and 7 days in both groups. There was no statistically significant difference between the two groups at day 1 or day 7 (p > 0.05). Histologic studies before and after arterial cryopreservation included standard and electron microscopy and showed that arteries had normal structure after cryopreservation. These results confirm that programmed cryopreservation with cryoprotectant does not alter the molecular or geometric configuration of collagen or elastic fibers. Endothelial cells were still present, however, their viability and function were not assessed.(ABSTRACT TRUNCATED AT 250 WORDS)