Donor to recipient ratios in the surgical treatment of vitiligo and piebaldism: a systematic review

Abstract

Stabilized vitiligo resistant to conventional therapy (e.g. segmental vitiligo) and piebaldism lesions can be treated with autologous cellular grafting techniques, such as non-cultured cell suspension transplantation (NCST) and cultured melanocyte transplantation (CMT). These methods are preferred when treating larger surface areas due to the small amount of donor skin needed. However, the donor to recipient expansion ratios and outcomes reported in studies with cellular grafting vary widely, and to date, no overview or guideline exists on the optimal ratio. The aim of our study was to obtain an overview of the various expansion ratios used in cellular grafting and to identify whether expansion ratios affect repigmentation and colour match. We performed a systematic literature search in MEDLINE and EMBASE to review clinical studies that reported the expansion ratio and repigmentation after cellular grafting. We included 31 eligible clinical studies with 1591 patients in total. Our study provides an overview of various expansion ratios used in cellular grafting for vitiligo and piebaldism, which varied from 1:1 up to 1:100. We found expansion ratios between 1:1 and 1:10 for studies investigating NCST and from 1:20 to 1:100 in studies evaluating CMT. Pooled analyses of studies with the same expansion ratio and repigmentation thresholds showed that when using the lowest (1:3) expansion ratio, the proportion of lesions achieving >50% or >75% repigmentation after NCST was significantly better than when using the highest (1:10) expansion ratio (v 2 P = 0.000 and v 2 P = 0.006, respectively). Less than half of our included studies stated the colour match between different expansion ratios, and results were variable. In conclusion, the results of our study indicate that higher expansion ratios lead to lower repigmentation percentages after NCST treatment. This should be taken into consideration while determining which expansion ratio to use for treating a patient.

Recipient-to-Donor Ratios in the Surgical Treatment of Vitiligo, Leukoderma, and Piebaldism: A Retrospective Review

“…These findings align with some prior research, in which authors demonstrated the lack of significant difference in repigmentation between low and high expansion ratio groups [4]. However, recent data, derived from a pooled analysis, showed that donor-to-recipient expansion ratio significantly correlated with the degree of repigmentation, with highest repigmentation rates observed in the low expansion ratio groups [5]. It is noteworthy that patients with SV were significantly more likely to achieve higher repigmentation rates compared to patients with NSV.…”

Electrofulguration‐assisted dermabrasion is comparable to manual dermabrasion in patients undergoing autologous non‐cultured epidermal cell suspension for treatment of stable vitiligo: A randomized controlled trial

“…Split skin thickness graft was harvested from a cosmetically hidden site such as thigh using a sharp shaving blade held by an artery forceps, under local anesthesia 7 . For ideal repigmentation, graft to recipient‐site ratio of 1:5 was maintained 8 . The NCES was then prepared in our laboratory using cold trypsinization as has been described in the literature previously 9…”

“…7 For ideal repigmentation, graft to recipient-site ratio of 1:5 was maintained. 8 The NCES was then prepared in our laboratory using cold trypsinization as has been described in the literature previously. 9 All lesions in a given patient scheduled for the intervention (NCES) were numbered and then randomized into two groups.…”

Meek micrografting: a novel surgical technique for the treatment of depigmentation

“…This technique has been simplified over the years and frequently seems to result in a good and uniform repigmentation, although NCES usually yields lower repigmentation success rates, when treating with a higher expansion ratio. 6 Furthermore, it is more time-consuming and requires chemical processing and trained personnel. 3 Summarizing, the abovementioned grafting techniques lack the capacity of easily treating large depigmented areas with high success rates.…”