UK based microsurgical training

This describes the UK history of the evolution of microsurgical training. The author has been involved since the start in 1979 and took a sole teaching role in the courses 2 years later. Before teaching microsurgery the necessary skills were obtained by the performance of various organ transplants in mice, rats and rabbits to investigate organ storage and immunosuppression. This experience identified the pitfalls of microsurgery and amplified the then identified need for meticulous microsurgical training. A basic microsurgical program was then instigated to provide step by step exercises of increasing difficulty. This consisted of microscope set-up, correct positioning, instruments, simulated suture exercises, dissection techniques, end to end arterial and venous anastomosis, end to side anastomosis, interpositional vein grafts, nerve anastomosis and groin flaps – all performed on an anaesthetised rat. Latterly we are now running advanced workshops incorporating supramicrosurgical exercises in the chicken (thigh) and the rat. The microsurgical workshops are still running 41 years later!

Surviving in a Frozen Forest: the Physiology of Eastern Spruce Budworm Overwintering

The eastern spruce budworm, Choristoneura fumiferana, is one of North America’s most destructive forest insects. It survives the harsh winters by deploying both a sophisticated diapause program and a complex suite of cryoprotective molecules. The spruce budworm’s cryoprotective biochemistry could revolutionize organ storage and transplants. Here we review the latest in C. fumiferana overwintering physiology and identify emerging theoretical and practical questions that are open for exploration.

Hyperbaric oxygenation in transplantology

The ability to eliminate any form of oxygen debt by transporting oxygen to organs and tissues, by dissolving it in body fluids, brings hyperbaric oxygenation to a new level of application in transplantology. The review discusses the pathophysiological aspects of hyperbaric oxygenation during ischemia and reinfusion, especially when used in transplantology, and also investigations on the use of hyperbaric oxygenation in model experiments and in clinical practice. Analysis of the efficacy of hyperbaric oxygenation therapy at various stages of the transplantation process (preconditioning, donation, organ storage, in the early and late post-transplant periods) allows us to conclude that this method should be more widely involved in transplantation practice.Authors declare no conflict of interest.

Combating Donor Organ Shortage: Organ Care System Prolonging Organ Storage Time and Improving the Outcome of Heart Transplantations

Introduction. Cardiovascular diseases are the number one cause of death globally contributing to 37% of all global deaths. A common complication of cardiovascular disease is heart failure, where, in such cases, the only solution would be to conduct a heart transplant. Every 10 minutes a new patient is added to the transplant waiting list. However, a shortage of human donors and the short window of time available to find a correct match and transplant the donors’ heart to the recipient means that numerous challenges are faced by the patient even before the operation could be done, reducing their chances of living even further. Methods. This review aims to evaluate the application of the Organ Care System (OCSTM) in improving the efficiency of heart storage based on journal articles obtained from PubMed, Elsevier Clinical Key, and Science Direct. Results. Studies have shown that OCS is capable of extending the ischemic time 120 minutes longer than conventional methods without any detrimental effect on the recipient nor donor’s safety. Based on the PROTECT I and PROCEED II study, 93% of transplantation recipients using the OCS system passed through the 30-day mortality period. Discussion. OCS is able to prolong the ischemic time of donors’ hearts by perfusing the organ at 34°C in a beating state, potentially reducing the detrimental effect of cold storage and providing additional assessment options. Another clear advantage is the implanting surgeon can assess the quality of the donor heart before surgery as well as providing a time safety buffer in unanticipated circumstances that will reduce the mortality risk of transplant recipients.