Immunosuppression maintenance in vascularized composite allotransplantation: what is just right?

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. Currently, although conventional immunosuppressive protocols have been successful at preventing allograft loss; they have not totally prevented episodes of acute rejection in the skin. Furthermore, vascularized composite allotransplantation carries a significant risk profile attributed to the complications of life-long, high-dose immunosuppression regimens.

SUMMARY: Examining conventional treatment protocols can lead to the development of novel immunosuppression concepts that will ultimately assist in favorably tilting the risk-benefit scale for these life-changing transplants.