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Vascularized composite allotransplantation

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184 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/28792625/the-effect-of-full-dose-composite-tissue-allotransplantation-immunosuppression-on-allograft-motor-nerve-regeneration-in-a-rat-sciatic-nerve-model
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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.
June 27, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28679959/longitudinal-immunological-characterization-of-the-first-presensitized-recipient-of-a-face-transplant
#8
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
#9
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
#10
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
https://www.readbyqxmd.com/read/28574951/single-artery-human-ear-graft-procurement-a-simplified-approach
#11
Jérôme Duisit, Hadrien Amiel, Donovan Debluts, Louis Maistriaux, Alexander Gerdom, Anne Bol, Pierre Gianello, Catherine Behets, Benoit Lengelé
BACKGROUND: In the field of experimental facial vascularized composite tissue allotransplantation (VCA), a human auricular subunit model, pedicled on both superficial temporal (STA) and posterior auricular (PAA) arteries was described. Clinical cases of extensive auricular replantation however, suggested that a single artery could perfuse the entire flap. In our 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...
May 31, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28538578/total-abdominal-wall-transplantation-an-anatomical-study-and-classification-system
#12
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/28422434/rat-hindlimb-cryopreservation-and-transplantation-a-step-toward-organ-banking
#13
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/28538571/angiosome-based-allografts-vascularized-composite-allotransplantation-for-tailored-subunit-reconstruction-with-volkmann-ischemic-contracture-as-a-case-in-point
#14
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
#15
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
#16
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/28493355/consideration-of-difficulties-and-exit-strategies-in-a-case-of-face-allotransplantation-resulting-in-failure
#17
Özlenen Özkan, Ömer Özkan, Umuttan Doğan, Vural Taner Yılmaz, Hilmi Uysal, Levent Ündar, Ebru Apaydın Doğan, Ozan Salim, Anı Çinpolat, Atilla Ramazanoglu
We describe the first rescue procedure in a case of total face allotransplantation. The recipient was a 54-year-old man with severe disfigurement of the entire face following an accidental gunshot injury 5 years previously. The large defect included the maxilla, mandible, and mid-face. Full face procurement was performed from a multiorgan cadaveric donor and was allotransplanted to the recipient. The post-transplant induction immunosuppressive regimen included ATG combined with tacrolimus, mycophenolate mofetil, and prednisone, while maintenance was provided by the last three of these...
May 11, 2017: Microsurgery
https://www.readbyqxmd.com/read/28445377/first-lower-two-thirds-osteomyocutaneous-facial-allograft-perfused-by-a-unilateral-facial-artery-outcomes-and-vascularization-at-1-year-after-transplantation
#18
Sebastian Fischer, Thomas C Lee, Nicco Krezdorn, Muayyad Alhefzi, Maximilian Kueckelhaus, Ericka M Bueno, Bohdan Pomahac
BACKGROUND: Facial allotransplantation provides a unique opportunity to restore facial form and function in severely disfigured patients. Using a single unilateral facial artery for vascularization can significantly reduce surgical duration and thus facilitate the practice of face transplantation. METHODS: A 33-year-old man with a history of high-energy ballistic trauma received a facial allograft comprising the lower two-thirds of the face, including maxilla and mandible...
May 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28390109/vascularized-composite-allograft-vca-donation-and-transplantation-a-survey-of-public-attitudes-in-the-united-states
#19
James R Rodrigue, David Tomich, Aaron Fleishman, Alexandra K Glazier
Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1,485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale...
April 8, 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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