Noninvasive Monitoring of Immune Rejection in Face Transplant Recipients

Kueckelhaus, Maximilian; Imanzadeh, Amir; Fischer, Sebastian; Kumamaru, Kanako K.; Alhefzi, Muayyad; Bueno, Ericka M.; Wake, Nicole; Gerhard‐Herman, Marie; Rybicki, Frank J.; Pomahac, Bohdan

doi:10.1097/prs.0000000000001703

Cited by 29 publications

(20 citation statements)

References 36 publications

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“…Although a histopathological classification system comparable to those in SOT exists, its value and reliability remain unsatisfactory (Cendales et al, ; Fischer et al, ). Concerns have arisen because rejection episodes requiring treatment interventions occurred without histopathological correlation, but rather in the presence of clinical alterations such as rash, redness, and swelling (Diaz‐Siso et al, ; Kueckelhaus, Fischer, et al, ; Kueckelhaus, Imanzadeh, et al, ). With regards to chronic rejection in VCA, our ability to detect is further impaired by the lack of markers or even as established definition for what is chronic rejection (Kanitakis, Petruzzo, Badet, et al, ; Kueckelhaus et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…Outcome reports from our own group and most of other face transplant teams worldwide narrowed this unique facial function down to the ability to smile . Kueckelhaus, Imanzadeh, et al, 2015). With regards to chronic rejection in VCA, our ability to detect is further impaired by the lack of markers or even as established definition for what is chronic rejection (Kanitakis, Petruzzo, Badet, et al, 2016;Kueckelhaus et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

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Software‐based video analysis of functional outcomes of face transplantation

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Software‐based video analysis of functional outcomes of face transplantation

et al. 2018

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“…10 Our group in Boston has also been very active in each of these areas. 40,41 We have also commented on the need for better reporting of outcomes. With only 35 cases overall performed and often scattered among many groups with single/limited experience, it is a priority to sustain more extensive communication of positive and negative results in unbiased manner.…”

Section: Challenges Facing the Futurementioning

confidence: 99%

Reflections on a Decade of Face Transplantation

2017

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On November 27, 2005, Isabelle Dinoire underwent the world's first partial face transplant in Amiens (France) after a dog attack had left her face severely disfigured. The abrupt surgical leap found the medical community and society unprepared to deal with the scientific, ethical, and societal implications of a surgical procedure that was striving to transition from sci-fi novels to science. Today, 10 years and over 35 transplants later, public opinion has become accustomed to the concept of "face restoration" through transplantation. However, face transplantation is far from being a safe "routine" surgery and the science behind it is still mostly unknown. Patients and multidisciplinary teams of physicians confront daily medical challenges, life-threatening risks, and personal struggle that only in part come to light. Could (or should) this be the laborious, uncertain, and high-risk trajectory of disruptive medical innovation? Over the last decade, some medical discoveries and surgical advancements in the field have been closely accompanied by partial regulatory frameworks, intense ethical discussions, and meaningful changes in social beliefs across cultures and continents. Yet, a very long way is to come and the questions we still have today greatly outweigh the answers we can offer. Here, we take the chance of the 10-year anniversary of face transplantation to reflect on the path traveled and to look forward to the challenges lying ahead.

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“…Because GV seems to be the most severe change of CR, in vivo imaging vascular studies that allow noninvasive visualization of vessels and assessment of intimal thickening and luminal narrowing appear as valuable tools for allograft monitoring and early diagnosis of CR. This is the case of high-resolution ultrasound biomicroscopy with appropriate probes capable of imaging small vessels, 24,46,48 a technique that allows the detection of the increase of vascular intimal thickness, which seems to be an early sign of GV. Compared with tissue biopsy, these noninvasive methods have the advantage that they can be repeated for regular patient monitoring as often as desired with no harm to the allograft, and furthermore allow assessment of a much broader vascular compartment.…”

Section: Diagnosismentioning

confidence: 99%

Chronic Rejection in Human Vascularized Composite Allotransplantation (Hand and Face Recipients)

et al. 2016

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Vascularized composite tissue allografts (VCA) have become a viable option to restore severely damaged parts of the body that cannot be repaired with conventional surgical techniques. Acute rejection develops frequently in the early postgraft period both in human and experimental VCA, but the possibility of human VCA to undergo chronic rejection (CR) remained initially unknown. The experience gained over the years shows that, similar to solid organ transplants (SOT), human VCA can also develop CR. Chronic rejection is clinically mostly apparent on the skin and targets preferentially skin and deep vessels, leading, as in SOT, to graft vasculopathy and often to graft loss. Dermal sclerosis and adnexal atrophy are additional features of CR. The pathogenetic immune mechanisms involved (cell-mediated versus humoral) remain incompletely known. The changes of CR can be detected with skin and deep tissue biopsies. Modern in vivo imaging tools can detect vascular narrowing and have the advantage of being noninvasive. However, the diagnosis and treatment of CR remain challenging, as several important questions remain to be answered: a more accurate definition of CR in VCA is needed to establish criteria allowing an accurate and early diagnosis. The pathogenetic mechanisms of CR need to be better understood to allow more efficacious treatment. Favoring/triggering factors of CR need to be better known so that they can be avoided. As in SOT, there is a need for efficient tolerance-inducing protocols that will favor graft acceptance and (ideally) circumvent the necessity of lifelong immunosuppression.

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Noninvasive Monitoring of Immune Rejection in Face Transplant Recipients

Abstract: Diagnostic, IV.

Cited by 29 publications

References 36 publications

Software‐based video analysis of functional outcomes of face transplantation

Software‐based video analysis of functional outcomes of face transplantation

Reflections on a Decade of Face Transplantation

Chronic Rejection in Human Vascularized Composite Allotransplantation (Hand and Face Recipients)

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