Factors Influencing Acute Rejection of Human Hand Allografts

Abstract

Acute rejection (AR) of human hand allografts (HHAs) may carry a risk of graft loss and leads to the need for immunosuppressive treatment. The literature on HHAs was reviewed to determine and evaluate the factors that trigger AR of HHAs. Clinical case reports of hand allograft transplantation published between 1999 and 2011 in English, French, or German were reviewed systematically. The number of AR episodes was the main outcome measure. Sixty-eight episodes of AR were described in 28 recipients. Calcineurin inhibitor-based maintenance regimens were associated with significantly fewer AR episodes than non-calcineurin inhibitor-based regimens (mean 1.9 vs 3.2; P = 0.018). In recipients who experienced cytomegalovirus infection, the mean number of episodes of AR was 4, whereas in those who did not experience cytomegalovirus infection it was 2.25 (P = 0.024). The planning of hand allograft transplantation should take these factors into account to minimize the risk of AR.

Acute rejection in vascularized composite allotransplantation

“…In some patients, CNI has been reportedly replaced with mTOR inhibitors, such as sirolimus, due to concerns about progressive CNI nephrotoxicity [40,41]. Although this change in maintenance immunosuppression preserves renal function, it is associated with an increased incidence of acute rejection [6]. These findings suggest that mTOR inhibitor is potentially less immunosuppressive than tacrolimus, consistent with similar observations in SOT [42].…”

“…Patients and chronic immunosuppressive regimens have an increased incidence of opportunistic infections, including cytomegalovirus (CMV) infection or reactivation. Active CMV infection has been associated with nearly twice as many acute rejection episodes when compared with patients without CMV infection (2.25 versus 4, P ¼ 0.024) [6]. This effect is related to the immunomodulatory nature of the CMV infection.…”

“…More than 80% of kidney transplants in the USA use induction therapy, whereas other SOT use it less often (lung $60%, heart $50% and liver $25%). There are three main agents used for induction therapy: Rabbit antithymocyte globulin (ATG; Thymoglobulin, Genzyme, Cambridge, MA, USA), Basiliximab (Simulect, Novartis, Basel, Switzerland) and Alemtuzumab (Campath, Genzyme, Cambridge, MA, USA) [6][7][8][9].…”

Vascularized Composite Allotransplant in the Realm of Regenerative Plastic Surgery

“…22 In total, there have been 89 hand transplants performed since 1998. 11 The greatest number of transplants have been performed in the United States, 27 followed by China 26 and Poland. 9 Successful replantation of fingers, thumbs, hands, and forearms have all been reported since the 1960s, [30][31][32] and established outcome scores for the evaluation of these patients' function have been applied to hand transplant recipients.…”

“…The extent of HLA mismatching has been linked to acute rejections as well as graft vasculopathy. 27,28 An important recent development is the decision by the US Department of Health and Human Services to recognize VCAs as organs, and therefore the procedures will be regulated by the Organ Procurement and Transplantation Network (OPTN) and comply with rules and policies set by the OPTN contractor UNOS. 29 With this decision, VCAs can now potentially be shared through the national UNOS system, therefore facilitating listing of patients and procurement of organs and potentially leading to an increase in the number of procedures that can be performed.…”