Current opinion in organ transplantation
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Curr Opin Organ Transplant · Jun 2014
ReviewChronic rejection in vascularized composite allografts.
To convey key issues surrounding chronic rejection in vascularized composite tissue allotransplantation (VCA), and to highlight pathologic features consistent with VCA chronic rejection. ⋯ As in solid organ transplantation, chronic rejection in VCA remains ill-defined. Transplant vasculopathy appears to be a key feature of chronic VCA rejection, whereas tertiary lymphoid follicles, graft fibrosis, and graft edema appear to be less-specific findings. Intimal hyperplasia can be detected with advanced imaging modalities.
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Curr Opin Organ Transplant · Dec 2013
ReviewVascularized composite allografts and solid organ transplants: similarities and differences.
Vascularized composite allotransplantation (VCA) is a treatment for complex tissue injuries and defects of extremities and face. During the past thirteen years, more than 100 VCA cases have been reported. Form and function restored with VCA have exceeded the results achieved with conventional surgical techniques. The review summarized the development in VCA over the past 12 months with references of and comparison with solid organ transplantation. ⋯ We herein summarize the progress made in VCA in the last year with a focus on new clinical immunosuppressive strategies and novel targets for immunosuppression and immunomodulation including the application of mesenchymal stem cells for transplant tolerance.
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Curr Opin Organ Transplant · Dec 2013
ReviewMonitoring and long-term outcomes in vascularized composite allotransplantation.
The field of vascularized composite allotransplantation (VCA) is young, with less than 150 transplants worldwide. However, we now possess as much as 14 years of clinical follow-up. There are similarities and distinct differences between solid-organ transplantation (SOT) and VCA. This review will summarize how VCA recipients are monitored, outcomes observed, and what aspects are unique to VCA. ⋯ Functional outcomes have exceeded expectations. VCA recipients enjoy a quality of life not achievable with conventional reconstruction. Outstanding long-term results of more than a decade have been achieved. Monitoring of VCA patients will require new strategies to incorporate external visualization and effects of environment on rejection. Graft loss has occurred early, suggesting we focus improvement on this time period. More follow-up is needed to determine the rates and targets of chronic rejection, and the characteristics of VCA unique to face vs. hand transplantation.
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Curr Opin Organ Transplant · Dec 2013
ReviewDonor and procurement related issues in vascularized composite allograft transplantation.
To understand the unique requirements of vascularized composite allograft (VCA) donation and procurement practices and the integral role of the established nationwide organ procurement organizations in organ procurement. ⋯ Improved VCA donation rates, procurement procedures and broader sharing nationwide of VCA donors will have important implications in advancing the emerging field of VCA transplantation.
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Curr Opin Organ Transplant · Dec 2013
ReviewVascularized composite allotransplantation: towards tolerance and the importance of skin-specific immunobiology.
Vascularized composite allotransplantation (VCA) is increasingly utilized in the restoration of complex injuries and tissue loss. Acute skin-targeted rejection episodes are common and concerns remain regarding the risks of conventional immunosuppression. We review current immunosuppressive regimens for VCA, progress with immunomodulatory and tolerance protocols, and highlight recent advances in cutaneous immunobiology which will have significant implications for future development in the field. ⋯ The majority of VCA centers utilize antibody-mediated induction, followed by double or triple-agent maintenance immunosuppression. A clinical trial of a minimal-immunosuppression protocol based on bone marrow infusion reports encouraging interim results, but long-term follow-up will be required. Skin remains the primary target of rejection in VCA. New data demonstrate extensive T-cell memory resident in skin, and complex interactions between these cells and epidermal Langerhans' cells will have implications for VCA rejection and tolerance, and warrant further investigation in the allogeneic setting.