Burlage Laura C, Tessier Shannon N, Etra Joanna W, Uygun Korkut, Brandacher Gerald
Department of Surgery, Center for Engineering in Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Surgery, Section Hepato-Pancreato-Bilibary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Curr Opin Organ Transplant. 2018 Oct;23(5):561-567. doi: 10.1097/MOT.0000000000000567.
In this review, we discuss novel strategies that allow for extended preservation of vascularized composite allografts and their potential future clinical implications for the field of vascularized composite allotransplantation (VCA).
The current gold standard in tissue preservation - static cold preservation on ice - is insufficient to preserve VCA grafts for more than a few hours. Advancements in the field of VCA regarding matching and allocation, desensitization, and potential tolerance induction are all within reasonable reach to achieve; these are, however, constrained by limited preservation time of VCA grafts. Although machine perfusion holds many advantages over static cold preservation, it currently does not elongate the preservation time. More extreme preservation techniques, such as cryopreservation approaches, are, however, specifically difficult to apply to composite tissues as the susceptibility to ischemia and cryoprotectant agents varies greatly by tissue type.
In the current scope of extended preservation protocols, high subzero approaches of VCA grafts will be particularly critical enabling technologies for the implementation of tolerance protocols clinically. Ultimately, advances in both preservation techniques and tolerance induction have the potential to transform the field of VCA and eventually lead to broad applications in reconstructive transplantation.
在本综述中，我们讨论了能够延长血管化复合组织异体移植保存时间的新策略及其对血管化复合组织异体移植（VCA）领域未来潜在的临床意义。
目前组织保存的金标准——冰上静态冷藏——不足以将VCA移植物保存数小时以上。VCA领域在配型与分配、脱敏以及潜在的免疫耐受诱导方面的进展都有望实现；然而，这些进展受到VCA移植物保存时间有限的限制。尽管机器灌注相对于静态冷藏有许多优势，但目前它并不能延长保存时间。然而，更极端的保存技术，如冷冻保存方法，特别难以应用于复合组织，因为不同组织类型对缺血和冷冻保护剂的敏感性差异很大。
在当前延长保存方案的范围内，VCA移植物的零下低温保存方法将成为临床上实施免疫耐受方案的关键 enabling 技术。最终，保存技术和免疫耐受诱导方面的进展有可能改变VCA领域，并最终导致其在重建移植中的广泛应用。 （注：原文中“enabling technologies”直接保留英文未翻译，可能是特定术语或有错误，需根据实际情况进一步确认准确含义。）
