From the Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University; and A. A. Cash Technology Ltd.
Plast Reconstr Surg. 2019 May;143(5):1074e-1080e. doi: 10.1097/PRS.0000000000005541.
Vascularized composite allotransplantation is the ultimate reconstructive tool when no other means of reconstruction are available. Despite its immense potential, the applicability of vascularized composite allotransplantation is hampered by high rejection rates and the requirement for high doses of immunosuppressive drugs that are associated with severe adverse effects and death. Because this is a non-life-saving procedure, widespread use of vascularized composite allotransplantation demands methods that will allow the reduction or elimination of immunosuppressive therapy. Efficient methods for the cryopreservation of biological cells and tissues have been sought for decades. The primary challenge in the preservation of viable tissue in a frozen state is the formation of intracellular and extracellular ice crystals during both freezing and thawing, which cause irreversible damage to the tissue. Recent proof-of-concept transplantations of a complete cryopreserved and thawed hindlimb in a rat model have demonstrated the potential of such methods. In the current review, the authors discuss how limb cryopreservation can attenuate or eliminate allograft rejection by either enabling better human leukocyte antigen matching or by adaptation of clinical tolerance protocols such as mixed chimerism induction. Also, the authors discuss the possible advantages of cryopreservation in autologous tissue salvage and cryopreservation following trauma. Clinical-grade cryopreservation may revolutionize the field of reconstruction, organ banking, and complex traumatic limb injury management.
血管化复合组织移植是在没有其他重建手段可用时的最终重建工具。尽管它具有巨大的潜力，但血管化复合组织移植的适用性受到高排斥率和需要高剂量免疫抑制剂的限制，这些免疫抑制剂会导致严重的不良反应和死亡。由于这是一种非挽救生命的程序，广泛应用血管化复合组织移植需要能够减少或消除免疫抑制治疗的方法。几十年来，人们一直在寻找高效的生物细胞和组织冷冻保存方法。在冷冻状态下保存存活组织的主要挑战是在冷冻和解冻过程中形成细胞内和细胞外冰晶，这会对组织造成不可逆转的损伤。最近在大鼠模型中进行的完整冷冻和解冻后后肢的概念验证移植证明了这些方法的潜力。在当前的综述中，作者讨论了肢体冷冻保存如何通过实现更好的人类白细胞抗原匹配，或通过适应混合嵌合诱导等临床耐受方案来减轻或消除同种异体移植物排斥反应。此外，作者还讨论了冷冻保存在自体组织保存和创伤后冷冻保存方面的可能优势。临床级别的冷冻保存可能会彻底改变重建、器官库和复杂创伤性肢体损伤管理领域。
