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Sub Normothermic Machine Perfusion In The Non-human Primate Partial Face Transplant Model: A Preliminary Study.
Haïzam Oubari, MD1, Loïc Van Dieren, MS1, Lucile Cabanel, MD1, Yanis Berkane, MD, PhD1, Mark A. Randolph, MAS1, Korkut Uygun, PhD1, Curtis L. Cetrulo, Jr., MD, PhD2, Alexandre G. Lellouch, MD, PhD1.
1Massachusetts General Hospital, Boston, MA, USA, 2Cedars Sinai Medical Center, Los Angeles, CA, USA.

PURPOSE: Vascularized composite allografts (VCAs) face substantial challenges, particularly in immunosuppression and ex vivo preservation. Subnormothermic machine perfusion (SNMP) offers a promising alternative to conventional static cold storage for preserving and reconditioning VCAs. This study investigates our extended SNMP protocol, optimized for non-human primate (NHP) VCAs, and its effects on graft immunogenicity.
METHODS: Partial facial grafts were procured from non-human primates (NHPs) weighing 4-8 kg (n=6) and perfused for 18 hours with non-recirculating Steen+ solution under a low-flow, high-oncotic protocol. Parameters including pressure, flow, weight gain, metabolic markers (lactate, pH, O₂, ions) were monitored. Pre- and post-perfusion tissue and perfusate samples were taken for analysis of the immune compartment (FACS), cytokine and gene expression profile as well as tissue histology.
RESULTS: The grafts' mean warm ischemia time was 3 hours before perfusion. Following 18 hours of continuous SNMP, mean weight gain was remained below 10%. Perfusion parameters and histology indicated stable ex vivo metabolic equilibrium and well-preserved tissues. Immune cell viability was maintained in the skin, with no major perfusion washout effect noticed, and the cellular stress response to perfusion was characterized.
CONCLUSION: We present the first application of continuous SNMP in the NHP partial face transplant model, advancing understanding of the model's response to extended ex vivo preservation and establishing a foundation for future ex vivo therapeutic uses in conjunction with tolerance induction protocols.
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