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Vascularized composite allotransplantation

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https://www.readbyqxmd.com/read/28303433/the-decade-of-face-transplant-outcomes
#1
Maria Siemionow
At the 10th year anniversary of the first face transplantation, 37 patients worldwide, were the recipients of faces coming from human donors. Five patients died due to complications, noncompliance with immunosuppressive medications and development of cancer. Despite the initial debates and ethical concerns, face transplantation became a clinical reality with satisfactory functional outcomes. The areas of controversy still include the impact of life-long immunosuppression on otherwise healthy patients as well as the selection process of face transplant candidates...
May 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/28249789/hand-transplantation-evolution-of-a%C3%A2-personal-outlook
#2
REVIEW
W P Andrew Lee
The field of vascularized composite allotransplantation-combining advances in reconstructive surgery, transplantation, and immunology-offers great promise for patients with heretofore unsolvable problems. In the last 30 years, hand transplantation has progressed through the phases of being a research subject, a controversial clinical procedure, a more widely accepted and expanding field, and now a promising endeavor undergoing refined indications. Although many lessons have been learned, few procedures in the author's experience have been as life-transformative in restoring the body image, motor and sensory functions, activities of daily living, and personal autonomy as successful hand transplantation...
February 26, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28211139/scabies-in-a-bilateral-hand-allograft-recipient-an-additional-mimicker-of-acute-skin-rejection-in-vascularized-composite-allotransplantation
#3
Jean Kanitakis, Emmanuel Morelon
Vascularized composite tissue allografts include skin, which frequently undergoes, in the early post-graft period, acute rejections. The diagnosis of acute rejection may be difficult as it can be mimicked by several dermatoses. We present a bilateral hand allograft recipient who developed, 16.5 years post-graft, cutaneous lesions raising suspicion about rejection. Physical examination and skin biopsy were diagnostic of scabies. This ectoparasitosis should be added in the list of dermatoses that can mimic allograft rejection in vascular composite allografts...
February 17, 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
https://www.readbyqxmd.com/read/28149214/robust-axonal-regeneration-in-a-mouse-vascularized-composite-allotransplant-model-undergoing-delayed-tissue-rejection
#4
Ying Yan, Matthew D Wood, Amy M Moore, Alison K Snyder-Warwick, Daniel A Hunter, Piyaraj Newton, Louis Poppler, Thomas H Tung, Philip J Johnson, Susan E Mackinnon
Background: Nerve regeneration in vascularized composite allotransplantation (VCA) is not well understood. Allogeneic transplant models experience complete loss of nerve tissue and axonal regeneration without immunosuppressive therapy. The purpose of this study was to determine the impact of incomplete immunosuppression on nerve regeneration. Methods: In this study, transgenic mice (4 groups in total) with endogenous fluorescent protein expression in axons (Thy1-YFP) and Schwann cells (S100-GFP) were used to evaluate axonal regeneration and Schwann cell (SC) migration in orthotopic-limb VCA models with incomplete immunosuppression using Tacrolimus (FK506)...
December 2016: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28121868/single-implantable-fk506-disk-prevents-rejection-in-vascularized-composite-allotransplantation
#5
Jignesh V Unadkat, Jonas T Schnider, Firuz G Feturi, Wakako Tsuji, Jacqueline M Bliley, Raman Venkataramanan, Mario G Solari, Kacey G Marra, Vijay S Gorantla, Alexander M Spiess
BACKGROUND: In vascularized composite allotransplantation, medication nonadherence leads to increased acute rejections. Improving medication adherence would improve overall allograft survival. Regionally delivered immunosuppression, targeted to sites of allorecognition, may reduce or eliminate the need for daily systemic immunosuppression. METHODS: The authors developed biodegradable FK disks containing FK506-loaded double-walled microspheres and tested their efficacy at preventing rejection in a Brown-Norway-to-Lewis rat hindlimb transplantation model...
February 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28118227/a-mouse-model-of-vascularized-skin-transplantation
#6
Jianke Ding, Yingjun Su, Shiqiang Liu, Yang Yang, Bo Zhou, Zhou Yu, Bo Xiao, Shuzhong Guo
BACKGROUND: Allogeneic skin tissues are highly antigenic and induce intensive immune rejection after composite tissue allotransplantation. Mouse models have advantages in mechanistic studies of immune rejection. However, due to technical challenge in vascular anastomosis with suture technique, mouse vascularized skin allotransplantation models are not widely used in studies of immune rejection. Therefore, the authors propose vascular anastomosis through cuff technique during allotransplantation of mouse donor free groin skin flaps to either recipient inguinal or cervical site...
January 23, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28079700/the-chimera-flap-a-quarter-century-odyssey
#7
Geoffrey G Hallock
Incredibly complicated multidimensional defects have always strained the ingenuity of the reconstructive surgeon. Secondary perhaps to vascularized composite allotransplantation as a solution to this dilemma, the compound flap has been developed to be a more useful and available alternative. Their greatest versatility has been proven by its subtype, the chimera flap. The chimera flap itself consists of multiple flaps, the latter possibly composed of bone, skin, muscle, and so on, where each part has an independent vascular supply, and each part is independent of any physical interconnection whatsoever with the other components, except where joined ultimately only to a common vascular pedicle...
February 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28058213/face-transplantation-anesthetic-challenges
#8
REVIEW
Aparna Dalal
Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products...
December 24, 2016: World Journal of Transplantation
https://www.readbyqxmd.com/read/28029476/a-murine-model-of-orthotopic-periorbital-subunit-transplantation
#9
Bowen Gao, Bin Li, Xinxin Li, Jinhong Bae, Kaiyan Xiao, Qingfeng Li, Hainan Zhu
BACKGROUND: Conventional reconstructive methods fail to achieve satisfactory results in total eyelid defect cases. Vascularized composite tissue allotransplantation might provide both good appearance and function for these patients. We developed an orthotopic periorbital transplantation model in rats to facilitate further experimentation in this field. METHODS: In anatomical studies, the vascular distribution to and innervation of the periorbital unit were identified and recorded...
March 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28024304/nasal-unit-transplantation-a-cadaveric-anatomical-feasibility-study
#10
Amir H Dorafshar, Gerhard S Mundinger, Brent Robinson, Sami Tuffaha, Gerald Brandacher, Patrick Byrne, Robert L Walton
Background The science and technical acumen in the field of vascularized composite allotransplantation has progressed rapidly over the past 15 years, and transplantation of specialized units of the face, such as the nose, appears possible. No study to date has evaluated the technical feasibility of isolated nasal unit transplantation (NUT). In this study, we explore the anatomy and technical specifics of NUT. Methods In this study, four fresh cadaver heads were studied. Bilateral vascular pedicle dissections were performed in each cadaver...
December 26, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27997448/the-retroauricular-approach-to-the-facial-nerve-trunk
#11
Jordan W Swanson, Jason W Yu, Jesse A Taylor, Stephen Kovach, Suhail Kanchwala, Laurent Lantieri
BACKGROUND: Exposure of the common trunk of the facial nerve has traditionally been approached based on principles of parotidectomy, which is associated with high rates of facial nerve palsy and landmarks that may be unreliable. On the basis of experience gained with vascularized composite allotransplantation of the face, the authors propose a retroauricular approach that may be more time-effective and safe. METHODS: In the proposed retroauricular facial nerve approach, an incision is made posterior to the ear in the retroauricular sulcus, and dissection proceeds anteriorly to the mastoid fascia to the base of the conchal bowl...
March 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27984520/vascularized-composite-allotransplantation-at-a-crossroad-adopting-lessons-from-technology-innovation-to-novel-clinical-applications
#12
Wendy K Dean, Simon G Talbot
No abstract text is available yet for this article.
March 2017: Transplantation
https://www.readbyqxmd.com/read/27975039/tumescent-technique-in-vascularized-composite-allotransplantation-secondary-surgery
#13
Alessandro Thione, Pedro C Cavadas
No abstract text is available yet for this article.
November 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27941036/the-miracle-of-face-transplantation-after-10-years
#14
REVIEW
Maria Siemionow
INTRODUCTION: At the 10th year anniversary of the first face transplantation, there are currently 36 patients worldwide, who are the recipients of faces coming from human donors. AREAS OF AGREEMENT: Despite the initial debates and ethical concerns, face transplantation became a clinical reality with satisfactory functional outcomes. AREAS OF CONTROVERSY: The areas of controversy still include the impact of lifelong immunosuppression on otherwise healthy patients as well as the selection process of face transplant candidates...
December 2016: British Medical Bulletin
https://www.readbyqxmd.com/read/27893612/the-influence-of-timing-and-frequency-of-adipose-derived-mesenchymal-stem-cell-therapy-on-immunomodulation-outcomes-after-vascularized-composite-allotransplantation
#15
Jan A Plock, Jonas T Schnider, Riccardo Schweizer, Wensheng Zhang, Wakako Tsuji, Matthias Waldner, Mario G Solari, Kacey G Marra, J Peter Rubin, Vijay S Gorantla
BACKGROUND: Cellular therapies for immunomodulation in vascularized composite allotransplantation (VCA) have gained importance due to their potential for minimization of immunosuppression. Adipose-derived (AD) mesenchymal stem cells (MSCs) especially have shown encouraging potential. We investigated the influence of timing and frequency of AD-MSC treatment on immunologic and graft survival as well as graft vasculopathy outcomes after VCA. METHODS: Lewis rats received full-mismatched Brown Norway rat hindlimb transplants...
January 2017: Transplantation
https://www.readbyqxmd.com/read/27879599/total-human-eye-allotransplantation-developing-surgical-protocols-for-donor-and-recipient-procedures
#16
Edward H Davidson, Eric W Wang, Jenny Y Yu, Juan C Fernandez-Miranda, Dawn J Wang, Nikisha Richards, Maxine Miller, Joel S Schuman, Kia M Washington
BACKGROUND: Vascularized composite allotransplantation of the eye is an appealing, novel method for reconstruction of the nonfunctioning eye. The authors' group has established the first orthotopic model for eye transplantation in the rat. With advancements in immunomodulation strategies together with new therapies in neuroregeneration, parallel development of human surgical protocols is vital for ensuring momentum toward eye transplantation in actual patients. METHODS: Cadaveric donor tissue harvest (n = 8) was performed with orbital exenteration, combined open craniotomy, and endonasal approach to ligate the ophthalmic artery with a cuff of paraclival internal carotid artery, for transection of the optic nerve at the optic chiasm and transection of cranial nerves III to VI and the superior ophthalmic vein at the cavernous sinus...
December 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27879593/triptolide-reduces-the-required-dose-of-tacrolimus-by-attenuating-inflammation-enhancing-immunosuppression-and-increasing-donor-chimerism-in-a-heterotopic-hindlimb-transplantation-model
#17
Chuan Gu, Fei Liu, Xusong Luo, Xianyu Zhou, Jun Yang, L Scott Levin
BACKGROUND: Induction of tolerance and minimizing the toxicity of immunosuppression are two fundamental goals in vascularized composite allotransplantation. Accumulating data indicate that triptolide is an agent that may have the capacity to suppress inflammation and immunologic rejection. METHODS: A heterotopic hindlimb allotransplantation model from Brown Norway to Lewis rats was established and treated with different doses of tacrolimus combined with or without triptolide...
December 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27859595/recipient-bone-marrow-derived-stromal-cells-prolong-graft-survival-in-a-rat-hind-limb-allotransplantation-model
#18
Ryosuke Ikeguchi, Ryosuke Kakinoki, Souichi Ohta, Hiroki Oda, Hirofumi Yurie, Yukitoshi Kaizawa, Hiroto Mitsui, Tomoki Aoyama, Junya Toguchida, Shuichi Matsuda
BACKGROUND: Recent studies have indicated that bone marrow-derived stromal cells (BMSCs) have immunomodulatory properties that suppress the T cell responses that cause graft rejection. The purpose of this study is to evaluate the effect of recipient BMSCs intravenous infusion for immunomodulation in a rat vascularized composite allotransplantation model. METHODS: A total of nine Wistar (WIS) rats and thirty Lewis (LEW) rats were used. BMSCs were harvested from three LEW rats...
November 17, 2016: Microsurgery
https://www.readbyqxmd.com/read/27826601/plasma-micrornas-are-potential-biomarkers-of-acute-rejection-after-hindlimb-transplantation-in-rats
#19
Hiroki Oda, Ryosuke Ikeguchi, Hirofumi Yurie, Yukitoshi Kaizawa, Souichi Ohta, Koji Yamamoto, Tomoki Aoyama, Shuichi Matsuda
BACKGROUND: The development of effective immunosuppressive regimens has resulted in many cases of successful hand transplantation. Visual skin inspection and histological evaluation are used to assess the rejection of hand transplants, but these methods are largely subjective. In this study, we aimed to determine the potential of microRNAs (miRNAs) as biomarkers for acute rejection in vascularized composite allotransplants. METHODS: In allograft group, 7 male Brown-Norway rats (RT1(n)) were used as donors and 13 male Lewis rats (RT1(l)) were used as recipients...
November 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27822384/immunomodulatory-role-of-mesenchymal-stem-cell-therapy-in-vascularized-composite-allotransplantation
#20
REVIEW
Richard Heyes, Andrew Iarocci, Yourka Tchoukalova, David G Lott
This review aims to summarize contemporary evidence of the in vitro and in vivo immunomodulatory effects of mesenchymal stem cells (MSCs) in promoting vascularized composite allotransplant (VCA) tolerance. An extensive literature review was performed to identify pertinent articles of merit. Prospective preclinical trials in mammal subjects receiving VCA (or skin allograft) with administration of MSCs were reviewed. Prospective clinical trials with intravascular delivery of MSCs in human populations undergoing solid organ transplant were also identified and reviewed...
2016: Journal of Transplantation
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