The International Registry on Hand and Composite Tissue Transplantation

Lanzettà, Marco; Petruzzo, Palmina; Margreiter, Raimund; Dubernard, Jean Michel; Schuind, Frédéric; Breidenbach, Warren C.; Lucchina, Stefano; Schneeberger, Stefan; Holder, C. Van; Granger, Darla K.; Pei, Guoxian; Zhao, Jinmin; Zhang, Xinying

doi:10.1097/01.tp.0000157118.28394.fa

Cited by 149 publications

(104 citation statements)

References 10 publications

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“…If a favorable gene expression profile (relative high FoxP3 gene expression) is identified from a biopsy, this AR episode can be viewed as a ''subclinical'' rejection episode and not treated. These findings would be very useful and relevant in clinical VCA where nearly all human recipients have undergone multiple AR episodes early in their posttransplant period with all receiving aggressive immunosuppressant boluses or pulsedosed steroids (1,2,8). Clinical appearance, though somewhat subjective, has been widely used to classify AR in VCA and has been shown to correlate with Banff histopathological grade (34).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Resolution of Acute Rejection and Tolerance Induction With IL-2 Fusion Protein in Vascularized Composite Allotransplantation

Jindal

Unadkat

Zhang

et al. 2015

American Journal of Transplantation

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y These authors contributed equally to this study.Vascularized composite allotransplantation (VCA) has emerged as a treatment option for treating nonlife-threatening conditions. Therefore, in order to make VCA a safe reconstruction option, there is a need to minimize immunosuppression, develop tolerance-inducing strategies and elucidate the mechanisms of VCA rejection and tolerance. In this study we explored the effects of hIL-2/Fc (a long-lasting human IL-2 fusion protein), in combination with antilymphocyte serum (ALS) and short-term cyclosporine A (CsA), on graft survival, regulatory T cell (Treg) proliferation and tolerance induction in a rat hind-limb transplant model. We demonstrate that hIL-2/Fc therapy tips the immune balance, increasing Treg proliferation and suppressing effector T cells, and permits VCA tolerance as demonstrated by long-term allograft survival and donor-antigen acceptance. Moreover, we observe two distinct types of acute rejection (AR), progressive and reversible, within hIL-2/Fc plus ALS and CsA treated recipients. Our study shows differential gene expression profiles of FoxP3 versus GzmB, Prf1 or interferon-g in these two types of AR, with reversible rejection demonstrating higher Treg to Teff gene expression. This correlation of gene expression profile at the first clinical sign of AR with VCA outcomes can provide the basis for further inquiry into the mechanistic aspects of VCA rejection and future drug targets.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Resolution of Acute Rejection and Tolerance Induction With IL-2 Fusion Protein in Vascularized Composite Allotransplantation

Jindal

Unadkat

Zhang

et al. 2015

American Journal of Transplantation

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“…The return of motor efficiency of the transplanted limbs may be assessed as good or very good. This is attested by the patients' ability to perform daily life activities and -in several cases -the return to work similar to that prior to the accident (3).…”

Section: Resultsmentioning

confidence: 99%

“…To date no cases of induction of a neoplastic process and no life-threatening complications have been recorded (3).…”

Section: Resultsmentioning

confidence: 99%

“…The current immunosuppression models are to a large extent based on the solutions applied in the case of transplants of parenchymatous organs and the growing number of observations of the histories of the ULTs already performed (3). Clinical trials indicate that multi-tissue transplants, when compared to transplants of parenchymatous organs, do not require any special immunosuppressive strategies (33).…”

Section: Immunosuppressionmentioning

confidence: 99%

“…The principal indication for the ULT procedure is the bilateral amputation of the upper limbs or the amputation of the dominant hand (3). Amputation at the central or more distal section of the forearm enables, because the outer muscle mass is left, a significant part of the movement function to be obtained without waiting long for reinnervation.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Upper Limb Transplantation - The Current State of Knowledge

Chełmoński¹,

Jabłecki²

2007

Polish Journal of Surgery

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Ethical Issues in Face Transplantation

2010

AMA Journal of Ethics

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The miraculous transplantation of a leg by the third-century saints Cosmas and Damian [1] became a medical reality in 1998 with the first successful hand transplant in France. In 2005, the same French team performed the first successful face transplant. Since then, 10 facial allotransplantations have been performed in France, China, the United States, and Spain. Two recipients are now dead as a result, one from tissue rejection and one from infection. Critics question whether the benefit is worth the risk. Plastic surgeons weigh Sir Harold Gillies' reconstructive principle of replacing like with like against the Hippocratic dictum primum non nocere, or "first do no harm." The risks of lifelong immunosuppression, including infection, malignancy, and end-organ toxicity, seem prima facie prohibitive in the context of a nonlifesaving intervention. But severe facial disfigurement to the degree that confers eligibility consideration is not a trivial thing. These are not merely "cosmetic defects," but conditions that render the patient unable to properly eat, breathe, or speak. Furthermore, the face is essential for communication and relating to others, which is the foundation for how we understand ourselves as human [2]. Restoring the face with composite tissue allotransplantation can provide results that are unattainable with current reconstructive techniques.

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The International Registry on Hand and Composite Tissue Transplantation

Abstract: Despite the enormous antigen load associated with composite tissue allograft, hand transplantation became a clinical reality with immunosuppression comparable to transplantation of solid organs.

Cited by 149 publications

References 10 publications

Spontaneous Resolution of Acute Rejection and Tolerance Induction With IL-2 Fusion Protein in Vascularized Composite Allotransplantation

Spontaneous Resolution of Acute Rejection and Tolerance Induction With IL-2 Fusion Protein in Vascularized Composite Allotransplantation

Upper Limb Transplantation - The Current State of Knowledge

Ethical Issues in Face Transplantation

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