Ann Liver Transplant.  2021 May;1(1):79-85. 10.52604/alt.21.0016.

Current vascular allograft procurement, cryopreservation and transplantation techniques in the Asan Medical Center Tissue Bank

• Hwang S
• Bae JH
• Kim IO
• Hong JJ

• KMID: 2560855
• DOI: http://doi.org/10.52604/alt.21.0016

Abstract

Vascular allografts are important materials to facilitate partial liver graft reconstruction in living donor liver transplantation (LDLT). Tissue banks are essential in providing vascular allografts used in LDLT. This study is intended to present the details of vascular allograft procurement, cryopreservation, and transplantation techniques, which are currently used in the Asan Medical Center Tissue Bank according to the standard operating procedure (SOP). Vascular allografts can be procured from the deceased organ donors or tissue donors. In practice, the majority of vessel donors are deceased multiorgan donors, thus the vessel grafts are harvested following multiorgan donation. The vascular allografts are cryopreserved according to the SOP and stored at —150°C in the vapor phase of liquid nitrogen. They can be kept for 10 years at the tissue bank. For clinical use, the cryopreserved vessel grafts are melted rapidly. At our institution, the majority of cryopreserved vascular allografts have been used for LDLT operations and some of them are also used for various hepatobiliary and vascular surgeries. In conclusion, the supply of vascular allografts through cryopreservation at the institutional tissue bank is an essential preparation to facilitate adult LDLT operations requiring various vascular reconstruction that use patches or conduits.

Keyword

Living donor liver transplantation; Tissue bank; Deceased donors; Cryopreservation; Vascular allograft

Figure

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  Figure 1 Intraoperative photographs of harvest for iliac artery and vein allografts following multiorgan procurement. The iliac artery and vein stumps (A) are pulled out from the inguinal areas (B). These vessels are dissected within the pelvis and inguinal areas (C). The harvested vessels are placed into an aseptic container filled with cold preservation solution (D).

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  Figure 2 Temperature curves of the programmed curve within the freezing chamber (red line) and actual temperature of the vascular graft specimen (blue line).

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  Figure 3 Process of cryopreservation of the vascular allografts. (A) A vascular graft is trimmed in a clean bench. (B) The vessel is dipped into a dimethyl sulfoxide-RPMI solution. (C) The aseptic plastic bags are closed using heat sealing. (D) The packed vessels are put into the computer-controlled freezing chamber.

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  Figure 4 Process of thawing the vascular allografts. (A) A packed vascular graft is taken out from the liquid nitrogen freezer. (B) The information at the outer package is identified. (C) A vessel in the plastic bag is melted in 40°C saline. (D) Dimethyl sulfoxide DMSO infiltrated in the vessel graft is removed with immersion into the serially diluted solutions.

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  Figure 5 Clinical application of vascular allografts. (A) An iliac vein is prepared after thawing. (B) The graft middle hepatic vein branches of the right liver graft are reconstructed with an iliac vein allograft conduit. (C) The graft middle hepatic vein branches of the right liver graft are reconstructed with an iliac artery allograft conduit. (D) The right portal vein is reconstructed using an iliac vein allograft conduit after segmental resection of the portal vein in a patient with perihilar cholangiocarcinoma.

Reference

References

1. Špaček M, Měřička P, Janoušek L, Štádler P, Adamec M, Vlachovský R, et al. 2019; Current vascular allograft procurement, cryopreservation and transplantation techniques in the Czech Republic. Adv Clin Exp Med. 28:529–534. DOI: 10.17219/acem/90037. PMID: 30684317.

2. Heng WL, Madhavan K, Wee P, Seck T, Lim YP, Lim CH. 2015; Banking of cryopreserved iliac artery and vein homografts: clinical uses in transplantation. Cell Tissue Bank. 16:235–242. DOI: 10.1007/s10561-014-9469-2. PMID: 25151404. PMCID: PMC4426133.

3. Vogt PR, Zünd G, Lachat M, Turina MI. 1998; Regarding "early rupture and degeneration of cryopreserved arterial allografts". J Vasc Surg. 27:189–190. DOI: 10.1016/S0741-5214(98)70309-X.

4. Lehalle B, Geschier C, Fiévé G, Stoltz JF. 1997; Early rupture and degeneration of cryopreserved arterial allografts. J Vasc Surg. 25:751–752. DOI: 10.1016/S0741-5214(97)70305-7.

5. Páral J, Ferko A, Mĕricka P, Slízová D, Nozicka J, Chovanec V, et al. 2000; [Preservation of venous grafts]. Rozhl Chir. 79:244–249. Czech.

6. Měřička P, Špaček M, Janoušek L, Dvořáček L, Štádler P, Vlachovský R, et al. 2015; Cryopreservation of vascular grafts for clinical use - retrospective analysis of pre-freezing factors with potential impact on the quality and safety of vascular transplantations. Cryobiology. 71:546–547. DOI: 10.1016/j.cryobiol.2015.10.041.

7. Aavik A, Kibur RT, Lieberg J, Lepner U, Aunapuu M, Arend A. 2019; Cold-stored venous allografts in different preserving solutions: a study on changes in vein wall morphology. Scand J Surg. 108:67–75. DOI: 10.1177/1457496918783728. PMID: 30319041.

8. Pegg DE, Wusteman MC, Boylan S. 1997; Fractures in cryopreserved elastic arteries. Cryobiology. 34:183–192. DOI: 10.1006/cryo.1996.1997. PMID: 9130389.

9. Jashari R, Van Hoeck B, Ngakam R, Goffin Y, Fan Y. 2013; Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels. Cell Tissue Bank. 14:589–599. DOI: 10.1007/s10561-012-9359-4. PMID: 23306651.

10. Goffin YA, Van Hoeck B, Jashari R, Soots G, Kalmar P. 2000; Banking of cryopreserved heart valves in Europe: assessment of a 10-year operation in the European Homograft Bank (EHB). J Heart Valve Dis. 9:207–214.

11. Song YC, Khirabadi BS, Lightfoot F, Brockbank KG, Taylor MJ. 2000; Vitreous cryopreservation maintains the function of vascular grafts. Nat Biotechnol. 18:296–299. DOI: 10.1038/73737. PMID: 10700144.

12. Aydin C, Ince V, Otan E, Akbulut S, Koc C, Kayaalp C, et al. 2013; Storage of allogeneic vascular grafts: experience from a high-volume liver transplant institute. Int Surg. 98:170–174. DOI: 10.9738/INTSURG-D-12-00035.1. PMID: 23701155. PMCID: PMC3723171.

13. Kim SH, Hwang S, Ha TY, Song GW, Jung DH, Ahn CS, et al. 2016; Usability of cryopreserved aortic allografts for middle hepatic vein reconstruction during living-donor liver transplantation. J Gastrointest Surg. 20:1049–1055. DOI: 10.1007/s11605-015-3048-0. PMID: 26666546.

14. Hwang S, Lee SG, Ahn CS, Park KM, Kim KH, Moon DB, et al. 2005; Cryopreserved iliac artery is indispensable interposition graft material for middle hepatic vein reconstruction of right liver grafts. Liver Transpl. 11:644–649. DOI: 10.1002/lt.20430. PMID: 15915499.

15. Sugawara Y, Makuuchi M, Tamura S, Matsui Y, Kaneko J, Hasegawa K, et al. 2006; Portal vein reconstruction in adult living donor liver transplantation using cryopreserved vein grafts. Liver Transpl. 12:1233–1236. DOI: 10.1002/lt.20786. PMID: 16724339.