This document discusses the history and techniques of organ preservation for transplantation. It covers key developments like the first organ transplants in the 1960s and approval of vascularized composite allograft transplantation in 2014. The main techniques discussed are hypothermic preservation using solutions like University of Wisconsin and histidine-tryptophan-ketoglutarate, as well as emerging trends like normothermic ex vivo perfusion and external perfusion systems. Organ preservation aims to minimize warm and cold ischemia time to reduce injury from hypothermia, ischemia, and reperfusion.

1. PERFUSSION OF VASCULAR
COMPOSITE ALLOGENIC
TISSUE(VCAT) TRANSPLANT
RN
MannuelTuttuPaul

3. HISTORY1
• 1869 First skin transplant
• 1954 First kidney b/w identical twins
• 1962/63 First Heart Lung Kidney transplant
• 2010 First Full Face
• 2014 VCAT APPROVED

4. Introduction2,3
• Organ Preservation is the supply line for
transplantation.
• Study byCALNERY and et al. (1963)4
• Work by Collins and his colleagues paved way
for preservation usingcollinssolution (24-36h)
Thus begin the journey of actual perfusion…

5. Pathophysiology
Injury of Tissue
1.HYPOTHERMIA
2.ISCHEMIA
Phases
1.Warm Ischemia(clamp time to perfusion)
2.Cold Ischemia(Perfusion to Reperfusion)

6. Pathophysiology
HypothermiaCell membrane disrupt
Permeability
Cell Swelling
IschemiaAnaerobic metabolism Fail Na+
pumpIntracellularHyperNa+
Ca2+
PermeabilityVasospasm

7. Reperfusion
IschemiaSuperoxide'sOxygen Free radicals
Re-perfusion injury
Re-perfusion Free radical
productionInteract with cell membrane
Cell Death

8. Organ Preservation Solutions

9. Ross Marshal Citrate
• Citrate Replace Phosphate
• Manitolinstead glucose
• Not commonly used

10. Euro Collins Solution
• HighConcK+,Phosphate,Glucose
• Heart ,Liver ,Lung

11. HTK
• InitiallyCardioplegia
• Histadine,Tryptophan,Ketoglutarate,Manitol
• Low Na+,K+,Mg2+
• Histadinebuffer
• TK,Manitolas oxygen scavenger
• Not yet confirmed studies of pancreatitis in
pancreatic transplant

12. UW
• Considered asstdfor renal ,liver, and pancreas
• Lower K+ helps in preventing vasospasm while
flushing

13. Organ Preservation
• Time is of essence for organ transplant
• Heart 5Hrs,Kidney40-50Hrs,Pancreas5-
15Hrs,Liver 6-12Hrs
• For Hand Depends on level of transplantation

14. Techniques of Preservation
1.Hypothermic
2.Freezing and thawing (Cryopreservation)
3.Vitrification( turn liquid to solid mass)
Hypothermia
Warm Ischemia <O2&ATP
Anerobic
100
c Cooling = 2 times reduction,370
c-00
c =12-13
times reduction

15. Cont.
• StaticCold Storage
• Hypothermic MachinePerfusion7
.

16. Emerging Trends
• NormothermicEx-vivo perfusion
• External PerfusionSystems
• Pulsatile perfusion8

18. References
1.https://organdonor.gov/about/facts-terms/history.html
2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088735/
3.https://emedicine.medscape.com/article/431140-overview#showall
4.RENALPRESERVATION BY ICE-COOLING: AN EXPERIMENTAL
STUDY RELATING TO KIDNEY TRANSPLANTATION FROM
CADAVERS.CALNE RY, PEGG DE, PRYSE-DAVIES J, BROWNFL
BrMed J. 1963 Sep 14; 2(5358):651-5.
5.https://www.ncbi.nlm.nih.gov/pubmed/28807212
6.https://www.ncbi.nlm.nih.gov/pubmed/28333889
7.https://www.ncbi.nlm.nih.gov/pubmed/28573190
8.https://www.researchgate.net/publication/275257408_Should_Pulsatile
_Preservation_Be_the_Gold_Standard_in_Kidney_Transplantation