Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 4, April, p. 529–534

doi: 10.17219/acem/90037

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Current vascular allograft procurement, cryopreservation and transplantation techniques in the Czech Republic

Miroslav Špaček1,A,B,C,D,F, Pavel Měřička2,A,B,C,D,E,F, Libor Janoušek3,B,E,F, Petr Štádler4,B,E,F, Miloš Adamec5,B,E,F, Robert Vlachovský6,B,E,F, Igor Guňka7,B,E,F, Pavel Navrátil8,E,F, Filip Thieme3,B,E,F, Rudolf Špunda1,B,C,E,F, Jan Burkert9,B,E,F, Robert Staffa6,C,E,F, Petr Němec10,A,E,F, Jaroslav Lindner1,A,E,F

1 2nd Department of Surgery – Department of Cardiovascular Surgery, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic

2 Tissue Bank, University Hospital Hradec Králové, Czech Republic

3 Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

4 Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic

5 Transplants Coordinating Center, Prague, Czech Republic

6 2nd Department of Surgery, St. Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic

7 Department of Surgery, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic

8 Transplant Center, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic

9 Department of Transplantation and Tissue Bank, University Hospital Motol, Prague, Czech Republic

10 Center of Cardiovascular Surgery and Transplantations Brno, Czech Republic

Abstract

Background. Vascular allotransplantations are performed worldwide in selected patients suffering from vascular prosthesis infection or critical limb ischemia. Either fresh or cryopreserved vascular allograft may be used.
Objectives. In various points, we address several aspects (allograft procurement, cryopreservation and transplantation technique) of the program of vascular allotransplantations in the Czech Republic.
Material and Methods. Vascular grafts retrieval has been done within multiorgan harvests using no-touch technique. Very short time of cold ischemia is achieved due to close cooperation with Tissue Establishment where the following processing of cryopreservation is performed. Meeting all necessary quality criteria is a prerequisity for releasing grafts for clinical application. Standardized thawing protocol and surgical handling aims to minimize microfractures before implantation.
Results. Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013 in the Czech Republic. The developement of storage of vascular tissue in banks was stimulated in 2000–2010 by the issue of EU directives and national harmonized norms, aimed at assurance of high quality and safety of cells and tissues used for transplantations in humans.
Conclusion. There are several crucial moments affecting final quality, including graft retrieval within a multiorgan harvest, short ischemic time, cryopreservation and thawing technique used. The recommended surgical handling during implantation may also affect results and graft-related complications.

Key words

tissue banking, cryopreserved vascular allograft transplantation, operative procedures, graft procurement, cryopreservation

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