Background. Donor-specific antibodies (DSAs) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact. Methods. We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome. Results. Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first 3 postoperative y). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge. Conclusions. While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring, and the relevance of an HLA class II match in UET recipients.

Differences in breast volume and contour are subjectively estimated by surgeons. 3D surface imaging using 3D scanners provides objective breast volume quantification, but precision and accuracy of the method requires verification. Breast volumes of five test individuals were assessed using a 3D surface scanner. Magnetic resonance imaging (MRI) reference volumes were obtained to verify and compare the 3D scan measurements. The anatomical thorax wall curvature was segmented using MRI data and compared to the interpolated curvature of the posterior breast volume delimitation of 3D scan data. MRI showed higher measurement precision, mean deviation (expressed as percentage of volume) of 1.10+/-0.34% compared to 1.63+/-0.53% for the 3D scanner. Mean MRI [right (left) breasts: 638 (629)+/-143 (138) cc] and 3D scan [right (left) breasts: 493 (497)+/-112 (116) cc] breast volumes significantly correlated [right (left) breasts: r=0.982 (0.977), p=0.003 (0.004)]. The posterior thorax wall of the 3D scan model showed high agreement with the MRI thorax wall curvature [mean positive (negative) deviation: 0.33 (-0.17)+/-0.37 cm]. High correspondence and correlation of 3D scan data with MRI-based verifications support 3D surface imaging as sufficiently precise and accurate for breast volume measurements.

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In the clinical scenario, optimal reconstruction of major facial defects of various origins is often very difficult. Composite tissue allografts (CTA) represent a therapeutic alternative without causing a donor site morbidity. The purpose of this study was the development of an experimental model for craniofacial allografts in dogs to test the feasibility of CTA. MATERIAL AND METHODSIn 10 adult non-related Beagle dogs, vascularized segmental left mandibular hemijoint grafts including the surrounding soft tissue were performed. Four dogs underwent autotransplantation (control). Allografts were exchanged between two animals in three pairs. The vascular pedible was reanostomosed to the jugular vein and artery. Osteotomies were fixed with compression plates. All allografted dogs received tacrolimus orally (1.0 mg/kg/d; Fujisawa Pharmaceuticals). Therapeutic drug levels were monitored. RESULTSNine of 10 animals became long-term survivors. One dog had to be sacrificed after 2 weeks for weight loss over 25%. The control autograft dogs were sacrificed after 1 year. One allograft dog developed intussusception and had to be sacrificed after 18 months. The remaining four dogs were sacrificed after 2.5 years. All long-term survivors had a good functional outcome, keeping their preoperative weight. Mouth opening was only reduced in one dog. Clinically, there were no signs of infection or instability of the bony junction. Xrays and histology demonstrated complete osseous integration of the grafts. Histologic examinations of the allograft muscles demonstrated viability. DISCUSSION AND CONCLUSIONSCurrently solid organ transplantations have become standard procedures, but CTA is still at the experimental level. In nonvascularized bone allografts the main complications, instability and infections, occur in of about 25% of the grafts. 1 Meanwhile, immediate revascularization of free bone autografts improves osseous integration. Allograft revascularization is combined with the disadvantage of an increase in immunogenecity, thus requiring immunosuppression. 2 Randzio et al 3 showed that long-term survival of vascularized hemimandible grafts with cyclosporine immunosuppression in rabbits is limited by a toxic wasting syndrome. Gold et al 4 reported only short-term survival of hemimandible transplants in two of four monkeys. The results of our study prove that vascularized partial

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