TY - JOUR
T1 - Mechanisms of rejection in vascular composite allotransplantation
AU - Etra, Joanna W.
AU - Raimondi, Giorgio
AU - Brandacher, Gerald
N1 - Funding Information:
The authors wish to acknowledge support from the Department of Defense (DoD), Reconstructive Transplantation Research Idea Discovery Awards (W81XWH-16-1-0708) and (W81XWH-16-1-0664).
Publisher Copyright:
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Purpose of review For patients with devastating injuries in whom standard reconstruction is not an option, vascularized composite allotransplantation (VCA) has become a viable means of restoring form and function. However, immunological rejection continues to be a problem in VCA and has not yet been fully characterized. As the field is relatively new, much of the data on rejection and immunosuppression have been extrapolated from that of solid organ transplantation. In this review, we cover the basic mechanisms of rejection as they relate specifically to VCA with analysis of recent literature and future directions. Recent findings Recent clinical studies have supported previously postulated T-cell-mediated mechanism of acute rejection and have also made strides in differentiating rejection from inflammation from other skin conditions and with different treatment regimens. Antibody-mediated rejection has been described in recent cases as well as treatment of presensitized patients receiving VCAs. With more long-term grafts, chronic changes, including vasculopathy, are being reported. Summary Clinically observed types of rejection in VCA include mainly cell-mediated, antibody-mediated and chronic rejection. Advances in diagnosis and treatment of rejection have been made, but there is still much to be learned about VCA-specific rejection.
AB - Purpose of review For patients with devastating injuries in whom standard reconstruction is not an option, vascularized composite allotransplantation (VCA) has become a viable means of restoring form and function. However, immunological rejection continues to be a problem in VCA and has not yet been fully characterized. As the field is relatively new, much of the data on rejection and immunosuppression have been extrapolated from that of solid organ transplantation. In this review, we cover the basic mechanisms of rejection as they relate specifically to VCA with analysis of recent literature and future directions. Recent findings Recent clinical studies have supported previously postulated T-cell-mediated mechanism of acute rejection and have also made strides in differentiating rejection from inflammation from other skin conditions and with different treatment regimens. Antibody-mediated rejection has been described in recent cases as well as treatment of presensitized patients receiving VCAs. With more long-term grafts, chronic changes, including vasculopathy, are being reported. Summary Clinically observed types of rejection in VCA include mainly cell-mediated, antibody-mediated and chronic rejection. Advances in diagnosis and treatment of rejection have been made, but there is still much to be learned about VCA-specific rejection.
KW - antibody-mediated rejection
KW - cell-mediated rejection
KW - vascularized composite allotransplantation
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U2 - 10.1097/MOT.0000000000000490
DO - 10.1097/MOT.0000000000000490
M3 - Review article
C2 - 29189293
AN - SCOPUS:85041463052
SN - 1087-2418
VL - 23
SP - 28
EP - 33
JO - Current opinion in organ transplantation
JF - Current opinion in organ transplantation
IS - 1
ER -