Sebastian Fischer1, Christine G Lian, Maximilian Kueckelhaus, Terry B Strom, Elazer R Edelman, Rachel A Clark, George F Murphy, Anil K Chandraker, Leonardo V Riella, Stefan G Tullius, Bohdan Pomahac. 1. aDivision 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.
Abstract
PURPOSE OF REVIEW: Acute rejection is the most common complication after vascularized composite allotransplantation (VCA). This review provides a state-of-the-art analysis of prevention, diagnosis and treatment of acute rejection episodes and highlights recent findings with the potential to improve patient care and enhance understanding of the underlying biologic processes. RECENT FINDINGS: Recent reports suggest that maintenance immunosuppression dose reduction and steroid withdrawal are realistic goals in VCA, despite the known high immunogenicity of the skin component. It appears that utilization of sentinel flaps, in-depth histological analyses and application of novel biomarkers have facilitated early diagnosis and characterization of acute rejection episodes, leading to timely institution of appropriate therapy. The successful management of the first highly sensitized face transplant recipient suggests the possibility of carefully considering these high-risk VCA candidates for transplantation. SUMMARY: Acute rejection is higher in VCA than in any other organ in the field of transplantation, although most episodes are controlled by high-dose steroids and optimization of maintenance immunosuppression. Because of limitations in patient number and the duration of follow-up, the long-term safety and effectiveness of VCA remain unclear. Moreover, the tests currently used to diagnose acute rejection are of limited value. Better diagnostic tools and a better understanding of the immunologic events during acute rejection are therefore needed to improve diagnosis, treatment and outcomes of this life-changing restorative surgery.
PURPOSE OF REVIEW: Acute rejection is the most common complication after vascularized composite allotransplantation (VCA). This review provides a state-of-the-art analysis of prevention, diagnosis and treatment of acute rejection episodes and highlights recent findings with the potential to improve patient care and enhance understanding of the underlying biologic processes. RECENT FINDINGS: Recent reports suggest that maintenance immunosuppression dose reduction and steroid withdrawal are realistic goals in VCA, despite the known high immunogenicity of the skin component. It appears that utilization of sentinel flaps, in-depth histological analyses and application of novel biomarkers have facilitated early diagnosis and characterization of acute rejection episodes, leading to timely institution of appropriate therapy. The successful management of the first highly sensitized face transplant recipient suggests the possibility of carefully considering these high-risk VCA candidates for transplantation. SUMMARY: Acute rejection is higher in VCA than in any other organ in the field of transplantation, although most episodes are controlled by high-dose steroids and optimization of maintenance immunosuppression. Because of limitations in patient number and the duration of follow-up, the long-term safety and effectiveness of VCA remain unclear. Moreover, the tests currently used to diagnose acute rejection are of limited value. Better diagnostic tools and a better understanding of the immunologic events during acute rejection are therefore needed to improve diagnosis, treatment and outcomes of this life-changing restorative surgery.
Authors: Juan M Colazo; Brian C Evans; Angel F Farinas; Salam Al-Kassis; Craig L Duvall; Wesley P Thayer Journal: Tissue Eng Part B Rev Date: 2019-08 Impact factor: 6.389
Authors: Christian Andreas Radu; Sebastian Fischer; Yannick Diehm; Otto Hetzel; Florian Neubrech; Laura Dittmar; Christian Kleist; Martha Maria Gebhard; Peter Terness; Ulrich Kneser; Jurij Kiefer Journal: Langenbecks Arch Surg Date: 2017-08-19 Impact factor: 3.445
Authors: Jeffrey L Platt; Christina L Kaufman; Mayara Garcia de Mattos Barbosa; Marilia Cascalho Journal: Curr Opin Organ Transplant Date: 2017-10 Impact factor: 2.640
Authors: T J Borges; J T O'Malley; L Wo; N Murakami; B Smith; J Azzi; S Tripathi; J D Lane; E M Bueno; R A Clark; S G Tullius; A Chandraker; C G Lian; G F Murphy; T B Strom; B Pomahac; N Najafian; L V Riella Journal: Am J Transplant Date: 2016-04-07 Impact factor: 8.086
Authors: Maximilian Kueckelhaus; Sebastian Fischer; Midas Seyda; Ericka M Bueno; Mario A Aycart; Muayyad Alhefzi; Abdallah ElKhal; Bohdan Pomahac; Stefan G Tullius Journal: Transpl Int Date: 2015-09-14 Impact factor: 3.782
Authors: Jasper Iske; Yeqi Nian; Ryoichi Maenosono; Max Maurer; Igor M Sauer; Stefan G Tullius Journal: Cell Mol Immunol Date: 2019-03-06 Impact factor: 11.530