Banking of cryopreserved iliac artery and vein homografts: clinical uses in transplantation
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Banking of cryopreserved iliac artery and vein homografts: clinical uses in transplantation Wee Ling Heng • Krishnakumar Madhavan • Priscilla Wee • Tracy Seck • Yeong Phang Lim Chong Hee Lim
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Received: 26 May 2014 / Accepted: 16 August 2014 Ó The Author(s) 2014. This article is published with open access at Springerlink.com
Abstract Iliac artery and vein homografts are critical for revascularization in living-donor liver transplantation. Since 2010, National Cardiovascular Homograft Bank and National University Hospital have collaborated in the pioneer endeavor of banking iliac vessel homografts for such surgeries in Singapore. This article aims to demonstrate that the processing, decontamination and cryopreservation techniques that our bank follow, help preserve iliac vessel homografts for a longer duration as compared to homografts preserved using short-term preservation techniques. This paper reports the first 4 years of postoperative outcome for recipients as a preliminary report for a longer-term outcome study. Criteria for donor assessment, techniques of iliac vessel homograft recovery, processing, decontamination, cryopreservation and storage according to the American Association of Tissue Banks standards are also described. From 2010 until 2013, we discovered of the iliac vessel homografts processed, 17 (94.4 %) were suitable for clinical use. Nine iliac artery grafts (64 %) and one iliac vein graft (14 %) were implanted. Irrespective of vessel type, homografts \90 mm in W. L. Heng (&) T. Seck Y. P. Lim C. H. Lim National Cardiovascular Homograft Bank, National Heart Centre Singapore, Singapore, Singapore e-mail: [email protected] K. Madhavan P. Wee National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore
length were of little use. Of the nine current iliac vessel homograft recipients, eight patients (89 %) had livingdonor liver transplantation and one patient (11 %) had reconstruction of the right internal carotid artery after resection of an aneurysm. Our preliminary results supports existing literatures that suggest cryopreserved iliac vessel homografts can be successfully used for revascularization in liver transplantation and reconstruction of carotid artery. Encouraging shortterm post-operative patient outcomes have been achieved, with no report of adverse event attributed to implanted homografts. We believe that our processing, decontamination and cryopreservation techniques have helped preserve the homografts for longer duration as compared to homografts preserved using short-term preservation techniques. Keywords Liver transplantation Allografts Artery Vein Cryopreservation
Introduction Artery or vein homografts are frequently used for vascular reconstruction in liver transplantation (Martı´nez et al. 1999). Recovery of vascular grafts was first recommended by Starzl et al. as a life-saving measure for an unexpected emergency; it provides additional vessel length for the recipient during organ transplantation (Starzl et a
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