Management Of Ischemia Duration In The First FVCA Re-transplantation: The Use Of A Novel Marine Oxygen Carrier M101
Alexandre G. Lellouch, MD1,2, Corentin B. Taveau, MD1,2, Curtis L. Cetrulo, Jr., MD FACS1, Laurent A. Lantieri, MD2.
1MGH, Boston, MA, USA, 2Service de Chirurgie Plastique, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
PURPOSE: Since the first facial vascularized composite allotransplantation (FVCA) performed in 2005 , the benefits in terms of aesthetics, function and quality of life are well-established. One of the main limiting factor to expand the donor pool is the ischemia duration. Indeed, ischemia damages tissue quality during preservation in a time-dependent manner, due to a lack of oxygen supply. Its impact on FVCA outcome has been demonstrated by a correlation between cold ischemia time and chronic rejection. We report the use of a novel natural oxygen carrier (M101, 2 g/L) in the first FVCA re-transplantation.
METHODS: In 2018, 8 years after his first face replacement due to a massive facial disfigurement in the setting of neurofibromatosis I (NF1), our team we performed for the second time a FVCA. The FVCA transplant was flushed through both external carotid arteries with heparinized saline until we got a blood free clear outflow and 2L of preservation solution supplemented withnatural oxygen carrier (M101, 2 g/L) to preserve in better condition the graft ex-vivo. This molecule is an extra cellular circulating hemoglobin from Arenicola marina with high oxygen affinity. This product was providedunder an exceptional TUA (Temporary Use Authorization). The graft was placed in a conventional portable preservation container at 4°C.
RESULTS: The FVCA was inset. The first end-to-end arterial anastomosis to the left external carotid perfused the entire VCA, then the right external carotid system was anastomosed. The cold ischemia time lasted 5:55 hours and warm ischemia was 1:55 hours. Venous end-to-side anastomoses were performed on the internal jugular vein. At the time of the clamp release, the FVCA showed clinical sign of revascularization after few seconds only.
We demonstrate for the first time the use of naturaloxygen carrier (M101, 2 g/L) for graft preservation in FVCA. This biological agent has been proven safe and efficient in this case report.
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