Upper Extremity Allotransplantation: Our Long-Term Experience in Lyon

Petruzzo, Palmina; Kanitakis, Jean; Gazarian, Aram; Dubernard, Jean Michel; Morélon, Emmanuel

doi:10.1007/978-3-031-21520-9_20

Cited by 1 publication

(2 citation statements)

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“…It was suggested that the ratio of facial/radial artery IT could be used as a benchmark parameter for the diagnosis of CR [29]. Another high-resolution ultrasonographic study performed with the Philips iU22 device with probe L15-7io in three UEA recipients investigated the arterial intimal media thickness (IMT), defined as the distance between blood-intima and mediaadventitia interface; it revealed a significant IMT increase and detected a digital artery thrombosis in a recipient who developed CR due to GV and lost his allograft [30,31]. Flow magnetic resonance imaging was used in two FA recipients and showed a decrease of the flow and obliteration of facial arteries concomitant with the development of skin changes suggestive of CR [32,33].…”

Section: In Vivo Imaging Techniquesmentioning

confidence: 99%

“…The role of DSA in CR of VCA is less clear, even though it remains likely [35], as suggested by single case reports of AMR [7,9 ▪ ,12 ▪ ,26]. In some patients, DSA are detected transiently and at low titers, with no clear association with (acute or chronic) rejection [31]. Occasionally, DSA appear in the blood after allograft removal [7].…”

Section: Surrogates For the Diagnosis Of Chronic Rejection In Vascula...mentioning

confidence: 99%

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Defining chronic rejection in vascularized composite allografts – do we have reliable surrogates to look for?

Kanitakis

2023

Current Opinion in Organ Transplantation

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Purpose of review Chronic rejection (CR) is a major threat in the field of vascularized composite tissue allografts (VCAs) as it causes graft dysfunction and usually graft loss. Unfortunately, knowledge of CR in VCA is incomplete because of the limited number of VCA recipients, the heterogeneous nature of VCAs and the short follow-up. Recent findings The diagnosis of CR in VCA has relied on clinical and pathological findings. Clinical changes include graft fibrosis, dyschromia and ischemic/necrotic ulcerations. Pathological changes primarily affect allograft vessels and manifest with graft vasculopathy (i.e. myo-intimal proliferation and luminal narrowing of allograft vessels, leading to graft ischemia). Attempts are made to diagnose CR with non- or minimally-invasive techniques, such as imaging studies (ultrasound biomicroscopy, functional magnetic resonance imaging) and serum biomarkers. These techniques provide interesting results and further insight into the mechanisms of CR in VCA. Summary The diagnosis of CR in VCA still relies mainly on clinicopathological graft alterations; unfortunately, these become overt rather late during the rejection process, when reversal of CR is problematic. More recent, minimally- or non-invasive techniques have provided encouraging results, but their usefulness in the diagnosis of CR requires further studies. These data highlight the paramount importance of CR prevention.

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