• Curr Opin Organ Transplant · Oct 2017

    Review

    Immunosuppression maintenance in vascularized composite allotransplantation: what is just right?

    • Molly Howsare, Christopher M Jones, and Allan M Ramirez.
    • aDepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine bDepartment of Surgery, Division of Hepatobiliary Surgery and Transplantation, University of Louisville cTrager Transplant Center, Jewish Hospital, Louisville, Kentucky, USA.
    • Curr Opin Organ Transplant. 2017 Oct 1; 22 (5): 463-469.

    Purpose Of ReviewOver the last two decades advances in vascularized composite allotransplantation have achieved clinically significant milestones. This review provides a synopsis for immunosuppressive maintenance therapy for VCA and discusses the nuances surrounding the determination of the right amount of immunosuppression in vascularized composite allotransplantation.Recent FindingsFunctional results after vascularized composite allotransplantation remain highly encouraging as are the immunologic outcomes, however, challenges persist. Currently, although conventional immunosuppressive protocols have been successful at preventing allograft loss; they have not totally prevented episodes of acute rejection in the skin. Furthermore, vascularized composite allotransplantation carries a significant risk profile attributed to the complications of life-long, high-dose immunosuppression regimens.SummaryExamining conventional treatment protocols can lead to the development of novel immunosuppression concepts that will ultimately assist in favorably tilting the risk-benefit scale for these life-changing transplants.

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