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Vascularized composite allotransplantation

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https://www.readbyqxmd.com/read/28930779/inhibition-of-lymphatic-drainage-with-a-self-designed-surgical-approach-prolongs-the-vascularized-skin-allograft-survival-in-rats
#1
Jiaomiao Pei, Yang Li, Chen Chen, Xi Zhang, Shiping Wang, Yajuan Song, Bei Liu, Yingjun Su, Shuzhong Guo
Vascularized composite allotransplantation (VCA) is an emerging treatment for significant tissue defects. However, VCAs usually consist of multiple highly antigenic skin tissues. Previous studies have shown that the lymphatic system in skin plays important roles in the initiation of immune responses during acute rejection, by transporting T cells and antigen-presenting dendritic cells to regional lymph nodes. Therefore, we designed a new surgical treatment to inhibit lymphatic drainage of skin allografts and investigated whether this approach could promote the survival of allografts and suppress immunological events after transplantation...
September 19, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28901186/recipient-adipose-derived-stem-cells-enhance-recipient-cell-engraftment-and-prolong-allotransplant-survival-in-a-miniature-swine-hind-limb-model
#2
Yur-Ren Kuo, Chien-Chang Chen, Yen-Chou Chen, Ching-Ming Chien
Donor mesenchymal stem cells (MSCs) could prolong vascularized composite allotransplantation (VCA) survival in our previous studies. However, recipient adipose tissue is easier to harvest than donor tissue for preconditioning modulation. Hence, this study investigated the efficacy of recipient autologous adipose-derived stem cells (rADSCs) for VCA survival. The heterotopic hind-limb transplantation from female donor to male recipient was performed in outbred miniature swine. Group I ( n = 6) was untreated controls...
August 2017: Cell Transplantation
https://www.readbyqxmd.com/read/28888310/role-of-facial-vascularized-composite-allotransplantation-in-burn-patients
#3
REVIEW
Deepak Bharadia, Indranil Sinha, Bohdan Pomahac
Face transplantation can provide improved quality of life to patients with extensive burn injuries. Facial vascularized composite allotransplantation (VCA) offers a new paradigm of treatment options, serving as a powerful reconstructive tool to restore facial form and function. Although currently facial VCA patients must follow a lifelong regimen of immunosuppression medications and suffer a risk of rejection, in properly selected patients, facial VCA can be a transformative operation and can improve quality of life...
October 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/28873074/adipose-derived-cellular-therapies-in-solid-organ-and-vascularized-composite-allotransplantation
#4
Katlin B Stivers, Jason E Beare, Paula M Chilton, Stuart K Williams, Christina L Kaufman, James B Hoying
PURPOSE OF REVIEW: Controlling acute allograft rejection following vascularized composite allotransplantation requires strict adherence to courses of systemic immunosuppression. Discovering new methods to modulate the alloreactive immune response is essential for widespread application of vascularized composite allotransplantation. Here, we discuss how adipose-derived cellular therapies represent novel treatment options for immune modulation and tolerance induction in vascularized composite allotransplantation...
October 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28829409/surgical-angiogenesis-in-porcine-tibial-allotransplantation-a-new-large-animal-bone-vascularized-composite-allotransplantation-model
#5
Dimitra Kotsougiani, Caroline A Hundepool, Joost I Willems, Patricia Friedrich, Alexander Y Shin, Allen T Bishop
Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic options have significant risk of failure and substantial morbidity. Use of bone vascularized composite allotransplantation (VCA) would offer both a close match of resected bone size and shape and the healing and remodeling potential of living bone. At present, life-long drug immunosuppression (IS) is required. Organ toxicity, opportunistic infection and neoplasm risks are of concern to treat such non-lethal indications...
August 13, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28823033/the-combination-of-mitomycin-induced-blood-cells-with-a-temporary-treatment-of-ciclosporin-a-prolongs-allograft-survival-in-vascularized-composite-allotransplantation
#6
Christian Andreas Radu, Sebastian Fischer, Yannick Diehm, Otto Hetzel, Florian Neubrech, Laura Dittmar, Christian Kleist, Martha Maria Gebhard, Peter Terness, Ulrich Kneser, Jurij Kiefer
BACKGROUND: Vascularized composite allotransplantation (VCA) is a rapidly expanding field of transplantation and provides a potential treatment for complex tissue defects. Peripheral blood mononuclear cells (PBMCs) shortly incubated with the antibiotic and chemotherapeutic agent mitomycin C (MMC) can suppress allogeneic T cell response and control allograft rejection in various organ transplantation models. MMC-incubated PBMCs (MICs) are currently being tested in a phase I clinical trial in kidney transplant patients...
August 19, 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/28804740/avascular-necrosis-of-the-humeral-head-following-bilateral-upper-extremity-vascular-composite-allotransplantation-a-case-report
#7
Jacob Rinkinen, David Molway, Matthew Carty, George S M Dyer, Bohdan Pomahac, Anil Chandraker, Simon G Talbot
Vascularised composite allotransplantation (VCA) represents an exciting and emerging field in plastic and reconstructive surgery. Despite the generally good functional and psychosocial outcomes, multiple complications can be associated with the procedure. The authors describe a case of avascular necrosis of the humeral head following successful upper extremity VCA.
2017: Case Reports in Plastic Surgery & Hand Surgery
https://www.readbyqxmd.com/read/28792625/the-effect-of-full-dose-composite-tissue-allotransplantation-immunosuppression-on-allograft-motor-nerve-regeneration-in-a-rat-sciatic-nerve-model
#8
Jong Pil Kim, Caroline A Hundepool, Patricia F Friedrich, Steven L Moran, Allen T Bishop, Alexander Y Shin
BACKGROUND: The purpose of this study was to identify which triple immunosuppressive protocols, currently used for vascularized composite allotransplantation in the clinic, will have the best effect on motor function recovery following nerve allograft reconstruction. METHODS: Eighty-eight Lewis rats underwent a 1-cm sciatic nerve allograft transplantation and skin graft from 44 Brown-Norway rats. Group I received 0.9% isotonic saline (control); Group II, 2 mg/kg FK506; Group III, 1 mg/kg FK506 with 15 mg/kg mycophenolate mofetil (MMF); and Group IV, 2 mg/kg FK506 with 30 mg/kg MMF and prednisone...
August 9, 2017: Microsurgery
https://www.readbyqxmd.com/read/28759463/immunosuppression-maintenance-in-vascularized-composite-allotransplantation-what-is-just-right
#9
Molly Howsare, Christopher M Jones, Allan M Ramirez
PURPOSE OF REVIEW: Over 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 FINDINGS: Functional results after vascularized composite allotransplantation remain highly encouraging as are the immunologic outcomes, however, challenges persist...
July 28, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28746417/immunological-and-inflammatory-mapping-of-vascularized-composite-allograft-rejection-processes-in-a-rat-model
#10
Or Friedman, Narin Carmel, Meirav Sela, Ameen Abu Jabal, Amir Inbal, Moshe Ben Hamou, Yakov Krelin, Eyal Gur, Nir Shani
BACKGROUND: Hand and face vascularized composite allotransplantation (VCA) is an evolving and challenging field with great opportunities. During VCA, massive surgical damage is inflicted on both donor and recipient tissues, which may contribute to the high VCA rejection rates. To segregate between the damage-induced and rejection phase of post-VCA responses, we compared responses occurring up to 5 days following syngeneic versus allogeneic vascularized groin flap transplantations, culminating in transplant acceptance or rejection, respectively...
2017: PloS One
https://www.readbyqxmd.com/read/28742686/bioengineering-a-human-face-graft-the-matrix-of-identity
#11
Jérôme Duisit, Louis Maistriaux, Adriano Taddeo, Giuseppe Orlando, Virginie Joris, Emmanuel Coche, Catherine Behets, Jan Lerut, Chantal Dessy, Giulio Cossu, Esther Vögelin, Robert Rieben, Pierre Gianello, Benoît Lengelé
OBJECTIVE: During the last decade, face allotransplantation has been shown to be a revolutionary reconstructive procedure for severe disfigurements. However, offer to patients remains limited due to lifelong immunosuppression. To move forward in the field, a new pathway in tissue engineering is proposed. BACKGROUND: Our previously reported technique of matrix production of a porcine auricular subunit graft has been translated to a human face model. METHODS: 5 partial and 1 total face grafts were procured from human fresh cadavers...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28737527/genitourinary-vascularized-composite-allotransplantation
#12
Ilse M Schol, Dicken S C Ko, Curtis L Cetrulo
PURPOSE OF REVIEW: Genitourinary vascularized allotransplantation (GUVCA) is gaining interest as a treatment option for patients with functional and aesthetic urogenital tissue loss. Only three cases have been done worldwide and research on the implementation and feasibility of this procedure is in an elementary state. RECENT FINDINGS: The psychosocial impact and ethical considerations with GUVCA are remote, particularly because of the intimate and personal nature of genital tissue...
July 22, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28734534/elbow-vascularized-composite-allotransplantation-surgical-anatomy-and-technique
#13
Zvi Steinberger, Heng Xu, Nikolas H Kazmers, Stephanie Thibaudeau, Russel G Huffman, L Scott Levin
BACKGROUND: Elbow reconstruction with vascularized composite allotransplantation (VCA) may hold promise in treating end-stage arthritis as no current treatment is both functional and durable. We describe the vascular and gross anatomy of the elbow in the context of VCA procurement and propose a step-by-step surgical technique for human elbow VCA. METHODS: We injected latex in the arterial tree of 16 fresh adult cadaveric upper extremities. We identified and measured arteries and nerves and their branch points relative to the medial epicondyle...
August 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28574951/single-artery-human-ear-graft-procurement-a-simplified-approach
#14
Jérôme Duisit, Hadrien Amiel, Donovan Debluts, Louis Maistriaux, Alexander Gerdom, Anne Bol, Pierre Gianello, Catherine Behets, Benoit Lengelé
In the field of experimental facial vascularized composite tissue allotransplantation, a human auricular subunit model, pedicled on both superficial temporal and posterior auricular arteries, was described. Clinical cases of extensive auricular replantation, however, suggested that a single artery could perfuse the entire flap. In this study, variants of this single-pedicle approach have been studied, aiming to develop a more versatile replantation technique, in which the question of venous drainage has also been addressed...
September 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28538578/total-abdominal-wall-transplantation-an-anatomical-study-and-classification-system
#15
David Light, Neilendu Kundu, Risal Djohan, Cristiano Quintini, Namita Gandhi, Brian R Gastman, Richard Drake, Maria Siemionow, James E Zins
BACKGROUND: Candidates for multivisceral transplantation present with complex defects often beyond traditional reconstructive options. In this study, the authors describe a dissection technique for a total abdominal wall vascularized composite flap. In addition, the authors suggest a classification system for complex abdominal wall defects. METHODS: Forty fresh, cadaveric hemiabdomens were dissected, with care taken to preserve the iliofemoral, deep circumflex iliac, superficial circumflex iliac, deep inferior epigastric, and superficial inferior epigastric arteries and corresponding veins...
June 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28538571/angiosome-based-allografts-vascularized-composite-allotransplantation-for-tailored-subunit-reconstruction-with-volkmann-ischemic-contracture-as-a-case-in-point
#16
G Ian Taylor, David S Sparks, Adam C Gascoigne, Russell J Corlett, Mark W Ashton
BACKGROUND: As we enter an age with new approaches to tissue reconstruction, the emphasis on the adage "like for like" has become even more relevant. This study illustrates the potential for several tailored vascularized composite allotransplantation reconstructive techniques and, in particular, for the management of Volkmann contracture. METHODS: Twenty fresh cadaver dissections and 30 archival lead oxide radiographic studies were examined to (1) identify potential upper limb vascularized composite allotransplantation donor sites (i...
June 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28525412/new-avenues-of-vascularized-composite-allotransplantation-and-their-potential-risks-and-benefits
#17
Sotirios Tasigiorgos, Nicco Krezdorn, Ericka Bueno, Bohdan Pomahac
No abstract text is available yet for this article.
August 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28452881/differential-inflammatory-networks-distinguish-responses-to-bone-marrow-derived-versus-adipose-derived-mesenchymal-stem-cell-therapies-in-vascularized-composite-allotransplantation
#18
Ruben Zamora, Sudheer K Ravuri, Jan A Plock, Yoram Vodovotz, Vijay S Gorantla
BACKGROUND: Vascularized composite allotransplantation (VCA) is aimed at enabling injured individuals to return to their previous lifestyles. Unfortunately, VCA induces an immune/inflammatory response, which mandates lifelong, systemic immunosuppression, with attendant detrimental effects. Mesenchymal stem cells (MSC)-both adipose-derived (AD-MSC) and bone marrow-derived (BM-MSC)-can reprogram inflammation and have been suggested as an alternative to immunosuppression, but their mechanism of action is as yet not fully elucidated...
July 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28422434/rat-hindlimb-cryopreservation-and-transplantation-a-step-toward-organ-banking
#19
A Arav, O Friedman, Y Natan, E Gur, N Shani
In 2016, over 5 million reconstructive procedures were performed in the United States. The recent successes of clinical vascularized composite allotransplantations, hand and face transplantations included, established the tremendous potential of these life-enhancing reconstructions. Nevertheless, due to limited availability and lifelong immunosuppression, application is limited. Long-term banking of composite transplants may increase the availability of esthetically compatible parts with partial or complete HLA matching, reducing the risk of rejection and the immunosuppressive burden...
April 19, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28371289/prolonged-cold-ischemia-time-results-in-local-and-remote-organ-dysfunction-in-a-murine-model-of-vascularized-composite-transplantation
#20
Néha Datta, Sean G Devaney, Ronald W Busuttil, Kodi Azari, Jerzy W Kupiec-Weglinski
Vascularized composite allotransplantation (VCA) is a viable reconstructive option for complex tissue defects. Although grafts with large muscular component may be uniquely susceptible to ischemia/reperfusion (I/R) syndrome, the safe cold ischemia time in VCA has not been established. We investigated the effects of cold ischemia on innate immune response and recipient survival in a murine orthotopic hindlimb transplantation model. Surprisingly, mice receiving grafts exposed to 6h or longer of cold storage demonstrated reduced survival and massive elevations in serum creatinine, BUN and creatine kinase, as compared to 1h of cold storage recipients...
March 30, 2017: American Journal of Transplantation
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