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Published on: April 26, 2019
Acute rejection in vascularized composite allotransplantation
Sebastian Fischer1, Christine G Lian, Maximilian Kueckelhaus
1aDivision of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA bDepartment of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen; University of Heidelberg Ludwigshafen, Germany cDivision of Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA dDepartment of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr-University, Bochum, Bochum, Germany eThe Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston fInstitute for Medical Engineering and Science, Cambridge gCardiovascular Division, Brigham and Women's Hospital hDepartment of Dermatology, Brigham and Women's Hospital iRenal Division, Schuster Family Transplantation Research Center, Brigham and Women's Hospital and Children's Hospital Boston jDivision of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Acute rejection is common in vascularized composite allotransplantation (VCA). Advances in diagnosis and treatment offer hope, but long-term outcomes and diagnostic tools require further research for VCA patients.
Area of Science:
- Transplantation immunology
- Regenerative medicine
- Surgical innovation
Background:
- Vascularized composite allotransplantation (VCA) faces acute rejection as a primary complication.
- Skin allografts in VCA present significant immunogenicity challenges.
- Understanding and managing rejection is crucial for VCA success.
Purpose of the Study:
- To provide a comprehensive review of acute rejection in VCA.
- To analyze current strategies for prevention, diagnosis, and treatment.
- To highlight recent advancements and future directions in VCA rejection management.
Main Methods:
- Review of current literature on VCA rejection.
- Analysis of diagnostic techniques including histology and biomarkers.
- Evaluation of treatment protocols and immunosuppression strategies.
Main Results:
- Dose reduction of maintenance immunosuppression and steroid withdrawal are increasingly feasible in VCA.
- Sentinel flaps, histological analysis, and biomarkers aid early rejection diagnosis.
- Successful transplantation in highly sensitized patients indicates expanded VCA candidacy.
Conclusions:
- Acute rejection rates in VCA are high but often manageable with current therapies.
- Long-term VCA safety and efficacy data are limited.
- Improved diagnostic tools and a deeper understanding of rejection mechanisms are essential for optimizing VCA outcomes.
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