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https://www.readbyqxmd.com/read/30102615/chronic-rejection-in-vascularized-composite-allotransplantation
#1
Emmanuel Morelon, Palmina Petruzzo, Jean Kanitakis
PURPOSE OF REVIEW: Vascularized composite allografts (VCA), which restore severely damaged body parts that cannot be repaired with conventional surgical techniques, often undergo acute skin rejection episodes in the early postgraft period. Although the risk of human VCA to be affected by chronic rejection was initially unknown, such cases were recently observed. RECENT FINDINGS: Chronic rejection targets preferentially the skin (dermal sclerosis, adnexal atrophy, necrosis) and vessels (graft vasculopathy) and may cause graft dysfunction, often resulting in ischemic graft loss...
August 9, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/30099732/a-hyperbaric-warm-perfusion-system-preserves-tissue-composites-ex-vivo-and-delays-the-onset-of-acute-rejection
#2
Charles Anton Fries, Carole Yasay Villamaria, Jerry Richard Spencer, Shari Lawson, Lin Wang, Thomas Raj, E George Wolf, Bijaya Kumar Parida, Vijay Saradhi Gorantla, Rory Frederick Rickard, Michael Robert Davis
BACKGROUND:  Ischemia-reperfusion injury (IRI) precipitates acute rejection of vascularized composite allografts (VCA). Hyperbaric preservation of tissues ex vivo, between harvest and revascularization, may reduce IRI and mitigate acute rejection of VCA. METHODS:  A porcine heterotopic musculocutaneous gracilis flap model was used. In phase 1, control autografts ( n  = 5) were infused with University of Wisconsin Solution (UWS) and stored at 4°C for 3 hours...
August 12, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/30091824/vascularized-composite-allotransplantation-in-the-united-states-a-descriptive-analysis-of-the-organ-procurement-and-transplantation-network-data
#3
Wida S Cherikh, Linda C Cendales, Christopher L Wholley, Jennifer Wainright, Vijay S Gorantla, David K Klassen, Sue McDiarmid, L Scott Levin
On July 3, 2014, the Organ Procurement and Transplantation Network/United Network for Organ Sharing was charged with the oversight of Vascularized Composite Allograft (VCA) procurement and transplantation in the U.S. As of December 31, 2017, 61 VCA programs at 27 centers were approved in the U.S. Fifty candidates have been added to the waiting list at 15 centers. Twenty-eight VCA transplants have been performed at 14 programs (10 upper limb, 10 uterus, 5 craniofacial, 1 scalp, 1 abdominal wall, and 1 penile)...
August 9, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/30080697/advances-in-machine-perfusion-organ-preservation-and-cryobiology-potential-impact-on-vascularized-composite-allotransplantation
#4
Laura C Burlage, Shannon N Tessier, Joanna W Etra, Korkut Uygun, Gerald Brandacher
PURPOSE OF REVIEW: In this review, we discuss novel strategies that allow for extended preservation of vascularized composite allografts and their potential future clinical implications for the field of vascularized composite allotransplantation (VCA). RECENT FINDINGS: The current gold standard in tissue preservation - static cold preservation on ice - is insufficient to preserve VCA grafts for more than a few hours. Advancements in the field of VCA regarding matching and allocation, desensitization, and potential tolerance induction are all within reasonable reach to achieve; these are, however, constrained by limited preservation time of VCA grafts...
August 4, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/30060833/combination-of-msc-spheroids-wrapped-within-autologous-composite-sheet-dually-protects-against-immune-rejection-and-enhances-stem-cell-transplantation-efficacy
#5
SangMin Kim, Yong-Seok Han, Jun Hee Lee, Sang Hun Lee
Mesenchymal stem cells (MSCs) are widely used in transplantation therapy due to their multilineage differentiation potential, abundance, and immuno-modulating ability. However, the risk of allograft rejection limits their application. Here, we proposed a novel method to facilitate MSC transplantation with enhanced applicability and efficacy. We cultured human adipose-derived MSCs in a 3D culture under in vitro expansion conditions and under conventional 2D adherent culture conditions. MSC spheroids promoted extracellular matrix molecules that stimulate MSC proliferation, and produced more angiogenic cytokines such as vascular endothelial growth factor, hepatocyte growth factor, and fibroblast growth factor than 2D-cultured MSCs...
August 2018: Tissue & Cell
https://www.readbyqxmd.com/read/30046652/kidney-dysfunction-after-vascularized-composite-allotransplantation
#6
Nicco Krezdorn, Sotirios Tasigiorgos, Luccie Wo, Rachel Lopdrup, Marvee Turk, Harriet Kiwanuka, Salman Ahmed, Palmina Petruzzo, Ericka Bueno, Bohdan Pomahac, Leonardo V Riella
Background: Kidney dysfunction is a major complication after nonrenal solid organ transplants. Transplantation of vascularized composite allografts (VCA) has yielded successful midterm outcomes despite high rates of acute rejection and greater requirements of immunosuppression. Whether this translates in higher risks of kidney complications is unknown. Methods: Ninety-nine recipients of facial or extremity transplants from the Brigham and Women's Hospital (BWH) and the International Registry on Hand and Composite Tissue Transplantation (IR) were reviewed...
July 2018: Transplantation Direct
https://www.readbyqxmd.com/read/29927830/living-donation-of-vascularized-composite-allografts
#7
Bohdan Pomahac, Muayyad Alhefzi, Ericka M Bueno, Sue V McDiarmid, L Scott Levin
Living donation has become a medically and ethically accepted practice in solid organ transplantation. Published proceedings from the international kidney transplant community and from the Ethics Committee of The Transplantation Society (TTS) articulated the general principles as well as specific recommendations for living donation, which remain the backbone of the Centers for Medicare and Medicaid Services (CMS) and Organ Procurement and Transplantation Network (OPTN) requirements and policies.Meanwhile, there have been major advancements in another revolutionary field of transplant medicine: vascularized composite allotransplantation, or VCA...
June 14, 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29888023/absence-of-rejection-in-a-facial-allograft-recipient-with-a-positive-flow-crossmatch-24-months-after-induction-with-rabbit-anti-thymocyte-globulin-and-anti-cd20-monoclonal-antibody
#8
Bruce E Gelb, J Rodrigo Diaz-Siso, Natalie M Plana, Adam Jacoby, William J Rifkin, Kimberly S Khouri, Daniel J Ceradini, Eduardo D Rodriguez
Background: Donor-specific antibodies (DSA) to human leukocyte antigen increase the risk of accelerated rejection and allograft damage and reduce the likelihood of successful transplantation. Patients with full-thickness facial burns may benefit from facial allotransplantation. However, they are at a high risk of developing DSA due to standard features of their acute care. Case Presentation: A 41-year-old male with severe disfigurement from facial burns consented to facial allotransplantation in 2014; panel reactive antibody score was 0%...
2018: Case Reports in Transplantation
https://www.readbyqxmd.com/read/29781949/optn-vascularized-composite-allograft-vca-waiting-list-current-status-and-trends-in-the-united-states
#9
Jennifer L Wainright, Christopher L Wholley, Wida S Cherikh, Jennifer M Musick, David K Klassen
BACKGROUND: Vascularized Composite Allograft (VCA) transplantation is a developing area in the field of transplantation. METHODS: This study used Organ Procurement and Transplantation Network (OPTN) VCA waiting list and transplant data from July 3, 2014 through February 28, 2018 to characterize the OPTN VCA waiting list in terms of composition, removal patterns, waiting time, resulting transplants, and trends over time. RESULTS: Between implementation of the OPTN VCA waiting list on July 3, 2014 and February 28, 2018, 54 candidates - 53...
April 30, 2018: Transplantation
https://www.readbyqxmd.com/read/29766640/subclinical-inflammation-phenotypes-and-long-term-outcomes-after-pediatric-kidney-transplantation
#10
Michael E Seifert, Megan V Yanik, Daniel I Feig, Vera Hauptfeld-Dolejsek, Elizabeth C Mroczek-Musulman, David R Kelly, Frida Rosenblum, Roslyn B Mannon
The implementation of surveillance biopsies in pediatric kidney transplantation remains controversial. Surveillance biopsies detect subclinical injury prior to clinical dysfunction, which could allow for early interventions that prolong allograft survival. We conducted a single-center retrospective cohort study of 120 consecutive pediatric kidney recipients, of whom 103 had surveillance biopsies ≤6 months posttransplant. We tested the hypothesis that subclinical inflammation (borderline or T cell-mediated rejection without clinical dysfunction) is associated with a 5-year composite endpoint of acute rejection and allograft failure...
May 15, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29746324/extracorporeal-perfusion-in-vascularized-composite-allotransplantation-current-concepts-and-future-prospects
#11
Maximilian Kueckelhaus, Flemming Puscz, Alexander Dermietzel, Mehran Dadras, Sebastian Fischer, Nicco Krezdorn, Bohdan Pomahac, Tobias Hirsch
Severe injuries of the face and limbs remain a major challenge in today's reconstructive surgery. Vascularized composite allotransplantation (VCA) has emerged as a promising approach to restore these defects. Yet, there are major obstacles preventing VCA from broad clinical application. Two key restrictions are (1) the graft's limited possible ischemia time, keeping the potential donor radius extremely small, and (2) the graft's immunogenicity, making extensive lifelong monitoring and immunosuppressive treatment mandatory...
June 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29673066/total-pancreaticoduodenectomy-with-autologous-islet-transplantation-14-years-after-liver-contained-composite-visceral-transplantation
#12
Ahmed Nassar, Cristiano Quintini, Guilherme Costa, Elizabeth Lennon, Rita Bottino, Betul Hatipoglu, Koji Hashimoto, Masato Fujiki, Fouad Kandeel, R Matthew Walsh, Kareem Abu-Elmagd
Chronic pancreatitis (CP) is a severely disabling disorder with potential detrimental effects on quality of life, gut function, and glucose homeostasis. Disease progression often results in irreversible morphological and functional abnormalities with development of chronic pain, mechanical obstruction, and pancreatic insufficiency. Along with comprehensive medical management, the concept of total pancreatectomy and islet autotransplantation (TP-AIT) was introduced 40 years ago for patients with intractable pain and preserved beta-cell function...
April 19, 2018: American Journal of Transplantation
https://www.readbyqxmd.com/read/29595532/development-of-an-ex-situ-limb-perfusion-system-for-a-rodent-model
#13
Emre Gok, Fares Alghanem, Ruth Moon, Erin Guy, Alvaro Rojas-Pena, Robert H Bartlett, Kagan Ozer
Ex-situ perfusion (ESP) is a promising method in preserving vascularized composite tissue allografts (VCAs) with potential to widen donor procurement to larger geographic areas. To optimize the method of preservation, we developed a small animal model to conduct biomolecular investigations. Twenty rat hind limbs (18.2 ± 1.3 g) were procured and connected to our custom-made ESP system. Perfusion pressure and flow parameters were measured with hourly blood gas analysis under near-normothermic (30-35˚C) conditions...
March 26, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29561493/lacrimal-apparatus-procurement-in-face-transplantation
#14
Asif Hasan, Colin Maciver, Gaoussou Toure, Jean-Paul Meningaud
The aesthetic outcome of a well-planned and executed vascularized composite tissue face allotransplant is unquestionable; however, complete functional restoration is necessary. The authors studied the possibility of restoring tear duct function in face transplant recipients. They also examined the technical specifics and feasibility of incorporating a lacrimal drainage apparatus into facial allografting. The authors performed a standardized face vascularized composite allograft on 4 hemi-faces (2 fresh cadavers)...
June 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29538261/disruption-of-the-gut-microbiota-with-antibiotics-exacerbates-acute-vascular-rejection
#15
Kevin Rey, Sukhbir Manku, Winnie Enns, Thea Van Rossum, Kevin Bushell, Ryan D Morin, Fiona S L Brinkman, Jonathan C Choy
BACKGROUND: The gut microbiota influences many immunological processes but how its disruption affects transplant rejection is poorly understood. METHODS: Interposition grafting of aortic segments was used to examine vascular rejection. The gut microbiota was disrupted in graft recipients using an antibiotic cocktail (ampicillin, vancomycin, metronidazole, neomycin sulfate) in their drinking water. RESULTS: Treatment of mice with antibiotics severely reduced total bacterial content in the intestine and disrupted the bacterial composition...
July 2018: Transplantation
https://www.readbyqxmd.com/read/29506828/effect-of-the-vascularized-bone-components-on-the-survival-of-vascularized-composite-allografts
#16
Jianwu Chen, Dongliang Zhang, Tao Zhang, Chen Chen, Yajuan Song, Shiqiang Liu, Yingjun Su, Shuzhong Guo
BACKGROUND: Vascularized composite allograft (VCA), such as hand and face allograft, contains a vascularized bone component that may provide an immunologic benefit and induce tolerance for the simultaneous inclusion of marrow cells and a marrow microenvironment. We developed a chimeric groin cutaneous/femur flap to investigate the effect of vascularized bone marrow on VCA survival and its ability to induce chimerism. METHODS: Brown Norway and Lewis rats were used as donors and recipients, respectively...
April 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29498981/anatomic-considerations-for-temporomandibular-joint-vascularized-composite-allotransplantation
#17
Nima Khavanin, Edward H Davidson, Diana Y Lee, Patrick Byrne, Amir H Dorafshar
Concomitant temporomandibular joint (TMJ) transplantation is an obvious advancement in the reconstructive armamentarium for face transplantation in scenarios involving TMJ ankylosis. This study investigates the fidelity of mandibular morphology and explores the feasibility of bilateral mandibular condyle transfer in facial vascularized composite allotransplantation. Geometric analysis was performed on 100 skeletally mature maxillofacial computed tomography scans. Exclusion criteria included mandibular trauma and dentoalveolar disease...
June 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29489486/achievements-and-challenges-in-facial-transplantation
#18
William J Rifkin, Joshua A David, Natalie M Plana, Rami S Kantar, J Rodrigo Diaz-Siso, Bruce E Gelb, Daniel J Ceradini, Eduardo D Rodriguez
: The first facial transplantation in 2005 ushered in a new era in reconstructive surgery, offering new possibilities for the repair of severe disfigurements previously limited by conventional techniques. Advances in allograft design, computerized preoperative planning, surgical technique, and postoperative revisions have helped push the boundaries in this new frontier of vascularized composite allotransplantation. Over the past 12 years, 40 of these procedures have been performed across the world, offering the field the opportunity to reflect on current outcomes...
August 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29441355/eponychial-lesions-following-bilateral-upper-extremity-vascular-composite-allotransplantation-a-case-report
#19
Fedra Fallahian, David Molway, Saagar Jadeja, Rachael Clark, Francisco M Marty, Leonardo V Riella, Anil Chandraker, Simon G Talbot
Vascularized composite allotransplantation represents a useful addition to reconstructive options available to the plastic surgeon. Though the procedure provides beneficial functional outcomes, there remain complications, often associated with the immunosuppression necessary to maintain an allograft. We report a case of eponychial fold lesions following successful bilateral upper extremity allotransplantation.
2018: Case Reports in Plastic Surgery & Hand Surgery
https://www.readbyqxmd.com/read/29343892/first-two-bilateral-hand-transplantations-in-india-part-4-immediate-post-operative-care-immunosuppression-protocol-and-monitoring
#20
Subramania Iyer, Mohit Sharma, P Kishore, Jimmy Mathew, R Janarthanan, Raghuveer Reddy, Abhijeet Wakure, Sundeep Vijayaraghavan, S M Chetan Mali, Visakh Varma, Ashish Chaudhari, Swapnil Dhake, Akshay Omkumar, George Kurian, Rajesh Nair, Anil Mathew, Zachariah Paul, Malini Eapen, Lalitha Biswas
Introduction: Being able to counter immune-mediated rejection has for decades been the single largest obstacle for the progress of vascular composite allotransplantation (VCA). The human immune system performs the key role of differentiating the 'self ' from the 'non-self '. This, although is quintessential to eliminate or resist infections, also resists the acceptance of an allograft which it promptly recognises as 'non-self'. Materials and Methods: Pre-operative evaluation of the recipient evaluation included immunological assessment in the form of panel reactive antibodies (PRA), human leucocyte antigen (HLA) typing, donor-specific antibody detection assays (DSA) and complement-dependent cytotoxicity assays (CDC)...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
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