Immunosuppression and Rejection in Human Hand Transplantation

Schneeberger, Stefan; Gorantla, Vijay S.; Hautz, Theresa; Pulikkottil, Benson J.; Margreiter, Raimund; Lee, W.P.A.

doi:10.1016/j.transproceed.2009.01.019

Cited by 39 publications

(21 citation statements)

References 36 publications

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“…Rejection in VCAs has the unique characteristic of being easily recognizable by visual inspection, which may be responsible of the high AR incidences found. 57,58 Adverse effects led to modification of the regimen in 32% of the recipients. Replacing Tac with SRL was indicated in 5 cases, because of increased levels of SCr.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Acute Rejection of Human Hand Allografts

Bonastre¹,

Landín²,

Díez³

et al. 2012

Annals of Plastic Surgery

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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.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Acute Rejection of Human Hand Allografts

Bonastre¹,

Landín²,

Díez³

et al. 2012

Annals of Plastic Surgery

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“…The hand and face transplantations performed in the last decade revealed that the skin of a CTA is not immediately or irreversibly rejected but might serve as a useful monitor tool for such a graft [12]. Acute rejection episodes of the skin occurred in 85% of patients with hand transplants within the first year [13] and were treated successfully with topical treatmentor or steroids, basiliximab, ATG and alemtuzumab [14].…”

Section: Discussionmentioning

confidence: 99%

Allograft vasculopathy after allogeneic vascularized knee transplantation

Diefenbeck¹,

Nerlich²,

Schneeberger³

et al. 2010

Transplant International

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Summary Composite tissue allotransplantation represents a new discipline in reconstructive surgery. Over the past 10 years, we have performed six human vascularized allogeneic knee transplantations. All of these grafts have been lost within the first 56 months. A histomorphologic assessment of the latest case resulted in the detection of diffuse concentric fibrous intimal thickening and occlusion of graft vessels. Findings are comparable with cardiac allograft vasculopathy. The lack of adequate tools for monitoring graft rejection might have allowed multiple untreated episodes of acute rejection, triggering myointimal proliferation and occlusion of graft vessels. Graft vasculopathy represents an obstacle to long‐term vascularized bone and joint allograft survival, and adequate tools for monitoring need to be developed.

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“…The phenomenon of “split tolerance” is associated with indefinite survival of the musculoskeletal portion, but rejection of the epidermis of VCA and has been reported in animal models [43]. It seems to be logical therefore to locally target the skin and avoid high degree of overall systemic immunosuppression [44]. However, the cumulative experience on the use of graft-delivered therapies in clinical VCA such as hand or face transplants is varied and inconsistent, leading to debate on the practical utility of such strategies.…”

Section: Site-specific Immunosuppression In Vcamentioning

confidence: 99%

Site-Specific Immunosuppression in Vascularized Composite Allotransplantation: Prospects and Potential

Schnider

Weinstock

Plock

et al. 2013

Clinical and Developmental Immunology

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Skin is the most immunogenic component of a vascularized composite allograft (VCA) and is the primary trigger and target of rejection. The skin is directly accessible for visual monitoring of acute rejection (AR) and for directed biopsy, timely therapeutic intervention, and management of AR. Logically, antirejection drugs, biologics, or other agents delivered locally to the VCA may reduce the need for systemic immunosuppression with its adverse effects. Topical FK 506 (tacrolimus) and steroids have been used in clinical VCA as an adjunct to systemic therapy with unclear beneficial effects. However, there are no commercially available topical formulations for other widely used systemic immunosuppressive drugs such as mycophenolic acid, sirolimus, and everolimus. Investigating the site-specific therapeutic effects and efficacy of systemically active agents may enable optimizing the dosing, frequency, and duration of overall immunosuppression in VCA with minimization or elimination of long-term drug-related toxicity.

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Immunosuppression and Rejection in Human Hand Transplantation

Cited by 39 publications

References 36 publications

Factors Influencing Acute Rejection of Human Hand Allografts

Factors Influencing Acute Rejection of Human Hand Allografts

Allograft vasculopathy after allogeneic vascularized knee transplantation

Site-Specific Immunosuppression in Vascularized Composite Allotransplantation: Prospects and Potential

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