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Vascularized composite allotransplantation

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194 papers 25 to 100 followers Includes face, upper limb and hand, uterine and penile transplantation
By Mafer Amber QxMD ambassador, Mexican med student currently in 4° year, doing clinical research in vascularized composite allotransplantation
https://www.readbyqxmd.com/read/21554424/achievements-and-challenges-in-composite-tissue-allotransplantation
#1
REVIEW
Stefan Schneeberger, Luis Landin, Jerzy Jableki, Peter Butler, Christoph Hoehnke, Gerald Brandacher, Emmanuel Morelon
Overall, more than 60 hand/forearm/arm transplantations and 16 face transplantations have been performed in the past 12 years. In the European experience summarized here, three grafts have been lost in response to a vascular thrombosis (n = 1), rejection and incompliance with immunosuppression (n = 1) and death (n = 1). The overall functional and esthetic outcome is very satisfactory, but serious side effects and complications related to immunosuppression are challenges hindering progress in this field. The high levels of immunosuppression, skin rejection, nerve regeneration, donor legislation and the acceptance level need to be addressed to promote growth of this promising new field in transplantation and reconstructive surgery...
August 2011: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/23001085/upper-extremity-transplantation-using-a-cell-based-protocol-to-minimize-immunosuppression
#2
Stefan Schneeberger, Vijay S Gorantla, Gerald Brandacher, Adriana Zeevi, Anthony J Demetris, John G Lunz, Diana M Metes, Albert D Donnenberg, Jaimie T Shores, Andrea F Dimartini, Joseph E Kiss, Joseph E Imbriglia, Kodi Azari, Robert J Goitz, Ernest K Manders, Vu T Nguyen, Damon S Cooney, Galen S Wachtman, Jonathan D Keith, Derek R Fletcher, Camila Macedo, Raymond Planinsic, Joseph E Losee, Ron Shapiro, Thomas E Starzl, W P Andrew Lee
OBJECTIVE: To minimize maintenance immunosuppression in upper-extremity transplantation to favor the risk-benefit balance of this procedure. BACKGROUND: Despite favorable outcomes, broad clinical application of reconstructive transplantation is limited by the risks and side effects of multidrug immunosuppression. We present our experience with upper-extremity transplantation under a novel, donor bone marrow (BM) cell-based treatment protocol ("Pittsburgh protocol")...
February 2013: Annals of Surgery
https://www.readbyqxmd.com/read/28658200/critical-ischemia-times-and-the-effect-of-novel-preservation-solutions-htk-n-and-tiprotec-on-tissues-of-a-vascularized-tissue-isograft
#3
Franka Messner, Theresa Hautz, Michael J F Blumer, Mario Bitsche, Elisabeth J Pechriggl, Martin Hermann, Bettina Zelger, Bernhard Zelger, Dietmar Öfner, Stefan Schneeberger
BACKGROUND: We herein investigate critical ischemia times and the effect of novel preservation solutions such as new histidine-tryptophan-ketoglutarate (HTK-N) and TiProtec on the individual tissues of a rat limb isograft. METHODS: Orthotopic hind-limb transplantations were performed in male Lewis rats after 2 hours, 6 hours, or 10 hours of cold ischemia (CI). Limbs were flushed and stored in HTK-N, TiProtec, HTK, or saline solution. Muscle, nerve, vessel, skin, and bone samples were procured on day 10 for histology, immunohistochemistry, confocal and electron microscopy, and quantitative real-time polymerase chain reaction analysis...
September 2017: Transplantation
https://www.readbyqxmd.com/read/28845920/ethical-issues-in-pediatric-face-transplantation
#4
Ana-Gabriela Benghiac, Jeremy R Garrett, Brian S Carter
Facial transplantation has become a reality in adult medicine. Children are subject to congenital craniofacial differences, disease-related, traumatic, or thermochemical craniofacial changes and might be suitable for face transplantation. This manuscript addresses unique ethical issues in considering potential pediatric face transplant. These challenges are operant at the individual, technologic, and psychosocial level for clinicians, investigators, and society.
August 28, 2017: Pediatric 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/28742686/bioengineering-a-human-face-graft-the-matrix-of-identity
#7
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
#8
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
#9
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/28804740/avascular-necrosis-of-the-humeral-head-following-bilateral-upper-extremity-vascular-composite-allotransplantation-a-case-report
#10
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
#11
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
#12
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/28742936/benefits-and-limitations-of-belatacept-in-4-hand-transplanted-patients
#13
J Grahammer, A Weissenbacher, B G Zelger, B Zelger, C Boesmueller, M Ninkovic, A Mühlbacher, I Peschel, G Brandacher, D Öfner, S Schneeberger
Belatacept (CTLA4Ig) is an emerging treatment in kidney transplantation. Lack of nephrotoxicity and possibly an inhibitory effect on the development of donor specific antibodies (DSA) make it an interesting agent in hand transplantation. In order to reduce CNI immunosuppression and preserve kidney function, we have added belatacept to the therapeutic regimen of 4 hand transplanted patients at month 4, at 6, 9, and 13 years after hand/forearm transplantation. Patients received 5mg/kg belatacept every 2 weeks, the dosing interval was extended to 4 weeks after 5 applications...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28746417/immunological-and-inflammatory-mapping-of-vascularized-composite-allograft-rejection-processes-in-a-rat-model
#14
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/28719391/pediatric-and-congenital-hand-transplantation
#15
Sandra Amaral, L Scott Levin
PURPOSE OF REVIEW: We review the approach and challenges associated with pediatric hand transplantation, including new knowledge gleaned from our recent case of bilateral hand-forearm transplantation in an 8-year old child. RECENT FINDINGS: Bilateral heterologous hand-forearm transplantation was performed in a child with a prior kidney transplant in July 2015. The initial surgery necessitated a large team of experts in microvascular surgery, transplant surgery, orthopedics and plastic surgery as well as pediatric anesthesia...
July 14, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28717523/assessment-of-emotional-expressions-after-full-face-transplantation
#16
Çağdaş Topçu, Hilmi Uysal, Ömer Özkan, Özlenen Özkan, Övünç Polat, Merve Bedeloğlu, Arzu Akgül, Ela Naz Döğer, Refik Sever, Nur Ebru Barçın, Kadriye Tombak, Ömer Halil Çolak
We assessed clinical features as well as sensory and motor recoveries in 3 full-face transplantation patients. A frequency analysis was performed on facial surface electromyography data collected during 6 basic emotional expressions and 4 primary facial movements. Motor progress was assessed using the wavelet packet method by comparison against the mean results obtained from 10 healthy subjects. Analyses were conducted on 1 patient at approximately 1 year after face transplantation and at 2 years after transplantation in the remaining 2 patients...
2017: Neural Plasticity
https://www.readbyqxmd.com/read/28654973/erosive-rheumatoid-arthritis-after-bilateral-hand-transplantation
#17
Brittany L Adler, Jemima Albayda, Jamie T Shores, W P Andrew Lee, Gerald Brandacher, Clifton O Bingham
No abstract text is available yet for this article.
August 1, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28679959/longitudinal-immunological-characterization-of-the-first-presensitized-recipient-of-a-face-transplant
#18
Thet Su Win, Naoka Murakami, Thiago J Borges, Anil Chandraker, George Murphy, Christine Lian, Victor Barrera, Shannan Ho Sui, David Schoenfeld, Jessica Teague, Ericka Bueno, Stefan G Tullius, Bohdan Pomahac, Rachael A Clark, Leonardo V Riella
Rejection affects greater than 80% of face transplants, yet no diagnostic criteria for antibody-mediated rejection (AMR) following face transplantation have been established. Given that different treatment strategies are required to address AMR and T cell-mediated rejection (TCMR), there is a critical need to delineate the features that can differentiate these two alloimmune responses. Here, we report the longitudinal immunological examination of what we believe to be the first and only highly sensitized recipient of a crossmatch-positive face transplant up to 4 years following transplantation...
July 6, 2017: JCI Insight
https://www.readbyqxmd.com/read/28361279/outcomes-after-hand-and-upper-extremity-transplantation
#19
REVIEW
Jaimie T Shores, Veronika Malek, W P Andrew Lee, Gerald Brandacher
Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify...
May 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/19741477/preliminary-results-of-bilateral-arm-transplantation
#20
LETTER
Luis Landin, Pedro C Cavadas, Peter Nthumba, Javier Ibañez, Francisco Vera-Sempere
No abstract text is available yet for this article.
September 15, 2009: Transplantation
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