Vascularized composite allotransplantation versus solid organ transplantation: innate-adaptive immune interphase

Abstract

Purpose of reviewVascularized composite allotransplantation (VCA), a life-enhancing treatment for patients with complex tissue defects, trauma or illness, expounds upon the foundation of solid organ transplantation (SOT), the gold standard in end-stage organ failure. As innate and adaptive immunity remain the fundamental concern, this review highlights divergent immunobiology responses in VCA and SOT recipients. Recent findingsHost innate immune activation drives peritransplant tissue ischemia-reperfusion injury (IRI). Despite the direct relationship between ischemia-reperfusion (IR)-stress and cell-mediated acute rejection, the mechanism of how IRI may affect VCA loss needs investigation. With skin grafts being highly immunogenic, the incidence of cell-mediated rejection is higher in VCA than SOT; whereas ex-vivo perfusion may exert cytoprotection against IRI in VCA and SOT. New treatment concepts, such as topical immunosuppression or cell-based tolerogenic therapies, may avoid systemic immunosuppression in VCA. Although antibody-mediated rejection is relatively rare in VCA and its disease seems to be distinct from that in SOT, little is known as to whether and how IRI may influence humoral immune rejection cascade in VCA or SOT.

Hesperidin ameliorates liver ischemia/reperfusion injury via activation of the Akt pathway

“…no. 3498), pro-caspase 3 Hepatocyte isolation and culture. Hepatocytes (HCs) were isolated as described previously (25).…”

“…Ischemia-reperfusion (IR) injury remains a key medical challenge because it relates to organ transplantation and alterations in vascular perfusion (1)(2)(3). Liver I/R injury frequently occurs as a result of liver transplantation, partial hepatectomy, hemorrhagic shock, trauma, severe infection and metabolic disorder (1,4).…”

Non-HLA Antibodies in Hand Transplant Recipients Are Connected to Multiple Acute Rejection Episodes and Endothelial Activation

“…Thus, we tentatively suggest that non-HLA antibodies may also be a part of high-risk immunologic profile capable of triggering a stronger alloimmune response and vasculopathy in VCA [27]. The fact that vasculopathy appears to be more pronounced in hand transplant patients than in solid-organ recipients may be because the skin is a very immunogenic tissue and the target for rejection-associated inflammation [28]. In the previous article we described the presence of non-HLA antibodies in combination with the occurrence of multiple rejection episodes found in one patient after bilateral hand transplantation [22].…”

“…Indeed, patients after kidney transplantation had higher concentrations of IL-6 than hand transplant recipients and control group (p = 0.002 and p = 0.005, respectively)-which may be caused by many factors [43][44][45] and is not the subject of this study. The role of the humoral response in rejection of solid organ transplantation has been well described [46][47][48] and much of the data on rejection in VCA have been extrapolated from that of solid organ transplantation [7,28,49]. It is also thought that in systemic sclerosis, humoral immune abnormalities link the vasculopathy [50][51][52].…”

Challenges and opportunities in vascularized composite allotransplantation of joints: a systematic literature review

“…This characteristic of JA resembles solid organ transplantation rather than other VCA, and theoretically renders it more vulnerable to immune recognition and rejection (39)(40)(41)(42)(43). Early detection of rejection in JA is challenging since the graft is usually embedded in recipient tissue (44,45). Therefore, the diagnosis of rejection mainly relies on patient complaints, which typically lag behind the occurrence of rejection.…”