Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread ap...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2021-11-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2021.00927 |
| _version_ | 1798004699506409472 |
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| author | Jerry Huanda Yang Ariel C. Johnson Salih Colakoglu Christene A. Huang David Woodbridge Mathes |
| author_facet | Jerry Huanda Yang Ariel C. Johnson Salih Colakoglu Christene A. Huang David Woodbridge Mathes |
| author_sort | Jerry Huanda Yang |
| collection | DOAJ |
| description | The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread application of VCAs is the side effect profile associated with the current immunosuppressive regimen, which can cause a wide array of complications such as infection, malignancy, and even death. Significant concerns remain regarding whether the treatment outweighs the risk. The potential solution to this dilemma would be achieving VCA tolerance, which would allow recipients to receive allografts without significant immunosuppression and its sequelae. Promising tolerance protocols are being studied in kidney transplantation; four major trials have attempted to withdraw immunosuppressive treatment with various successes. The common theme in all four trials is the use of radiation treatment and donor cell transplantation. The knowledge gained from these trials can provide valuable insight into the development of a VCA tolerance protocol. Despite similarities, VCAs present additional barriers compared to kidney allografts regarding tolerance induction. VCA donors are likely to be deceased, which limits the time for significant pre-conditioning. VCA donors are also more likely to be human leukocyte antigen–mismatched, which means that tolerance must be induced across major immunological barriers. This review also explores adjunct therapies studied in large animal models that could be the missing element in establishing a safe and stable tolerance induction method. |
| first_indexed | 2024-04-11T12:28:36Z |
| format | Article |
| id | doaj.art-f9971549a92240978da89d7d9c4ced46 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-11T12:28:36Z |
| publishDate | 2021-11-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-f9971549a92240978da89d7d9c4ced462022-12-22T04:23:52ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712021-11-01480670371310.5999/aps.2021.009273925Clinical and preclinical tolerance protocols for vascularized composite allograft transplantationJerry Huanda Yang0Ariel C. Johnson1Salih Colakoglu2Christene A. Huang3David Woodbridge Mathes4Division of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Aurora, CO, USADivision of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Aurora, CO, USADepartment of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USADivision of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Aurora, CO, USADivision of Plastic and Reconstructive Surgery, University of Colorado School of Medicine, Aurora, CO, USAThe field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread application of VCAs is the side effect profile associated with the current immunosuppressive regimen, which can cause a wide array of complications such as infection, malignancy, and even death. Significant concerns remain regarding whether the treatment outweighs the risk. The potential solution to this dilemma would be achieving VCA tolerance, which would allow recipients to receive allografts without significant immunosuppression and its sequelae. Promising tolerance protocols are being studied in kidney transplantation; four major trials have attempted to withdraw immunosuppressive treatment with various successes. The common theme in all four trials is the use of radiation treatment and donor cell transplantation. The knowledge gained from these trials can provide valuable insight into the development of a VCA tolerance protocol. Despite similarities, VCAs present additional barriers compared to kidney allografts regarding tolerance induction. VCA donors are likely to be deceased, which limits the time for significant pre-conditioning. VCA donors are also more likely to be human leukocyte antigen–mismatched, which means that tolerance must be induced across major immunological barriers. This review also explores adjunct therapies studied in large animal models that could be the missing element in establishing a safe and stable tolerance induction method.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2021.00927vascularized composite allograftstransplantationimmunosuppressionface transplantationhand transplantation |
| spellingShingle | Jerry Huanda Yang Ariel C. Johnson Salih Colakoglu Christene A. Huang David Woodbridge Mathes Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation Archives of Plastic Surgery vascularized composite allografts transplantation immunosuppression face transplantation hand transplantation |
| title | Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation |
| title_full | Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation |
| title_fullStr | Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation |
| title_full_unstemmed | Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation |
| title_short | Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation |
| title_sort | clinical and preclinical tolerance protocols for vascularized composite allograft transplantation |
| topic | vascularized composite allografts transplantation immunosuppression face transplantation hand transplantation |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2021.00927 |
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