Vascularized bone marrow-based immunosuppression inhibits rejection of vascularized composite allografts in nonhuman primates

R. N. Barth, E. D. Rodriguez, G. S. Mundinger, A. J. Nam, J. S. Ha, H. Hui-Chou, L. S. Jones, A. Panda, S. T. Shipley, C. B. Drachenberg, D. Kukuruga, S. T. Bartlett

Research output: Contribution to journalArticlepeer-review

Abstract

Vascularized composite allograft (VCA) transplantation (also referred to as composite tissue allotransplantation) has demonstrated clinical success in cases of hand, arm and face transplantation despite prior belief that skin provides an insurmountable barrier to allograft rejection. These overall good outcomes are facilitated by substantial immunosuppressive requirements in otherwise healthy patients, yet still demonstrate frequent rejection episodes. We developed a nonhuman primate model of facial segment allotransplantation to elucidate the unique pathophysiology and immunosuppressive requirements of VCA with addition of concomitant vascularized bone marrow (VBM). Heterotopically transplanted facial segment VCA with VBM treated only with tacrolimus and mycophenolate mofetil (MMF) demonstrated prolonged rejection-free survival, compared to VCA without VBM that demonstrated early rejection episodes and graft loss. While VCA with VBM demonstrated sporadic macrochimerism, acute and chronic rejection and graft loss occurred after discontinuation of immunosuppression. These data support an immunomodulatory role of VBM in VCA that reduces immunosuppressive requirements while providing improved outcomes.

Original languageEnglish (US)
Pages (from-to)1407-1416
Number of pages10
JournalAmerican Journal of Transplantation
Volume11
Issue number7
DOIs
StatePublished - Jul 2011

Keywords

  • Bone marrow
  • chimerism
  • composite tissue allograft
  • nonhuman primate
  • rejection
  • tolerance

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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