Postoperative Nursing and Nutrition Support in Non-Human Primate Recipients of Combined Donor-Matched Vascularized Osteomyocutaneous and Renal Allografts

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IntroductionWe established a novel non-human primate (NHP) model for renal transplants performed concomitantly with donor-matched vascularized ostemomyocutaneous allotransplantation (VOMA) (including distal 1/3 of femur). The success of this model is predicated not only upon robust mirosurgical techniques and effective immune induction/suppression protocols, but more importantly on comprehensive pre- and postoperative monitoring/caring and nutritional support. Here in, we present our protocol for pre/postoperative nursing and nutrition in this challenging NHP solid organ-vacularized composite allograft model to ensure optimal surgical and graft survival outocmes.Methods1) Full MHC mismatched, ABO matched, 4-5 year-old (3-4.5 kg) cynomolgus male-female (donor-recipient) NHP pairs were used for concomitant donor-matched renal-VOMA transplantation (distal 1/3 of femur). Induction consisted of ATG (2 doses, Day -4 and -1) and total body irradiation (TBI) (100 cGy, Day -1). Maintenance therapy consisted of cyclosporin A (CSA, i.m., b.i.d) with target range of 400-600 ng/ml. Bolus Methyl-prednisone was given (40 mg, i.v.) daily starting 5-day post-surgery for 5 days. 2). Special post-operative jackets were designed and used to prevent automutilation of abdominal and inguinal incisions. Antibiotic coverage was provided for 5 days post-surgery. 3) 20 ml of autologus blood was transfused twice at 2-4 and 12-15 days post-surgery. Recipients blood was obtained at 2-week and 3-weeks prior to surgery and banked for transfusion. 4) Female recipients received daily progesterone from 4 day prior to surgery for 4 weeks to suppress menstrual blood loss. In addition, recombinant EPO was given every other day for 2 weeks starting from 4 days prior to surgery. 5)Nutritional support was provided with Complete Nutrition Rice Powder (100 ml soup) delivered via daily gastric tube feeding for two weeks post-surgery. In addition to the tube feeds, apples and corn cakes were given orally when the recipients were ready for oral intake.Results1) No acute rejection or opportunistic infections occurred up to 60 days so far post operation. 2) Recipient WBC were >2x109/L and the RBC were above 3x1012/L. Renal and liver function were normal. 3) Abdominal and inguinal wounds healed in 7 to 10 days. 4) The mental and physiological status of NHP returned to normal after the significant surgical procedure with this nursing regimen. These recipients will be followed up to study the impact of concomitant donor-matched vascularized osteomyocutaneous allografts on renal allograft tolerance.ConclusionA thorough pre/postoperative nursing and nutrition program is a critical component of success with translational NHP transplants protocols to ensure effective response to immunosuppressive and surgical interventions and expeditious recovery/rehabilitation with minimal morbidity after these complex and challenging procedures.National Natural Science Foundation of China. Wuhan University Zhongnan Hospital Science Foundation.

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