Provided herein are perfusate compositions, and methods and systems for using such composition to perfuse a vascularized
composite tissue (e.g., limb, face,
abdominal wall or flap) to preserve such composite tissues (e.g., for auto or allotransplant). In certain embodiments, the perfusate compositions comprise at least one of the following reagents: i) N-
acetylcysteine; ii) pantothenate or
pantothenic acid at a concentration of at least 15 micromol /
liter in said composition; and / or iii)
carnitine, as well as further comprising one of the following: i) at least one
bicarbonate / CO2-dependent anaplerotic substrate, and at least one
bicarbonate / CO2 buffer, or ii) at least one non-
bicarbonate / CO2-dependent anaplerotic substrate. In certain embodiments, the perfusate compositions are free, or detectably free, of alpha amino acids.