Establishing a Swine Model to Study Whole Eye Transplant Dynamic Preservation and Transplantation

Haïzam Oubari; Lucile Cabanel; Yanis Berkane; Loïc Van Dieren; Barry L. Bentley; Maxime Jeljeli; Mark A. Randolph; Basak E. Uygun; Korkut Uygun; Curtis L. Cetrulo Jr.; Alexandre G. Lellouch

doi:10.3791/69179

A subscription to JoVE is required to view this content. Sign in or start your free trial.

Method Article

Establishing a Swine Model to Study Whole Eye Transplant Dynamic Preservation and Transplantation

610 views

⸱

DOI:

10.3791/69179

⸱

November 25th, 2025

Haïzam Oubari¹^,²^,³^,⁴ , Lucile Cabanel¹^,²^,³ , Yanis Berkane¹^,²^,⁵ , Loïc Van Dieren¹^,²^,³^,⁶ , Barry L. Bentley¹^,²^,⁷^,⁸ , Maxime Jeljeli⁹ , Mark A. Randolph²^,³ , Basak E. Uygun¹^,² , Korkut Uygun¹^,² , Curtis L. Cetrulo Jr.²^,³^,⁹ , Alexandre G. Lellouch¹^,²^,³^,⁹

¹Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, ²Shriners Children's Boston, ³Plastic Surgery Research Laboratory, Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, ⁴Department of Plastic, Reconstructive and Aesthetic Surgery, Hospices Civils de Lyon, ⁵Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, University of Rennes, ⁶Faculty of Medicine and Health Sciences, University of Antwerp, ⁷Bioengineering Research Group, Cardiff Metropolitan University, ⁸Collaboration for the Advancement of Sustainable Medical Innovation, University College London, ⁹Division of Plastic Surgery Research, Vascularized Composite Allotransplantation Program Development, Cedars-Sinai Hospital

Summary

A detailed and reproducible swine whole eye transplant model (WET) is described, from surgical procurement to the initiation of machine perfusion, allowing for the study of WET dynamic preservation in transplantation.

Abstract

The very first human Whole Eye Transplant (WET) has sparked new hope for patients who have lost vision due to major ophthalmic injury, but significant challenges remain to be addressed before vision restoration through WET can become achievable. Among these, one of the most critical challenges is ex vivo preservation. The eyeball, particularly its neural components such as the retina and optic nerve, undergoes rapid and irreversible degeneration within minutes unless proper preservation is ensured. Static cold storage (SCS) remains the gold standard in vascularized composite allotransplantation (VCA) but is not suited to WET ex vivo preservation due to its inability to sufficiently suppress or support metabolism, leading to loss of graft viability and function. Subnormothermic machine perfusion (SNMP) has emerged as a promising alternative to SCS, offering the potential not only to preserve grafts but also to recondition them. Our group has successfully translated SNMP from solid organ transplantation to several VCA models, demonstrating its feasibility and advantages. Herein, we report the application of SNMP to preserve a WET in swine, detailing the anatomical model and preservation protocol. This approach represents a significant step forward in optimizing WET preservation and transplantation techniques.

Introduction

Vascularized composite allotransplants (VCAs) represent a significant advancement in reconstructive surgery, offering unparalleled aesthetic and functional outcomes for patients with complex lesions¹^,². However, eyeball-related vision loss remains a major source of impairment in face injuries. The recent first whole eye transplant (WET) has sparked new hope for patients³^,⁴. Although the sight was not regained, functional imaging demonstrated cortical activation in response to light stimulation, and electroretinography (ERG) indicated a blunted but reco....