Perfusion-Limited Efficacy of Platelet-Rich Plasma in Adipose Tissue Grafts

Autologous adipose tissue (AT) grafting is often compromised by insufficient early vascularization, leading to ischemia, fibrosis, and inconsistent long-term volume retention. Incorporating platelet-rich plasma (PRP) into AT bioinks offers a clinically accessible means to enhance vascular recruitment, but the in vivo impact of PRP dosage remains unclear. Here, we investigated how PRP concentration, uniformly integrated into a previously reported clinically relevant AT bioink, regulates vascular infiltration, tissue remodeling, and overall graft survival. High-dose PRP markedly improved graft performance, including an 8-fold increase in highly perfused regions, a 3.8-fold enhancement in adipocyte survival, a 1.67-fold reduction in fibrosis, and a 2.51-fold increase in collagen III deposition compared with PRP-free AT grafts. Histological analysis further demonstrated that PRP mitigates the adverse effects of poor perfusion, reducing regional disparities in survival and extracellular matrix (ECM) remodeling. High-dose PRP also maximized graft retention, preserving 103% of graft mass relative to 50.6% in native AT. Together, these results establish a clear in vivo dose-response relationship for PRP-enhanced AT grafts and highlight platelet concentration as a key design parameter for soft-tissue reconstruction. This work provides a translational framework for optimizing PRP-functionalized bioinks to improve clinical outcomes in reconstructive surgery.