Characterization, Prophylaxis, and Treatment of Infectious Complications in Craniomaxillofacial and Upper Extremity Allotransplantation

Broyles, Justin M.; Alrakan, Mohammed; Ensor, Christopher R.; Khalifian, Saami; Kotton, Camille N.; Avery, Robin K.; Brandacher, Gerald; Lee, W. P. Andrew; Gordon, Chad R.

doi:10.1097/prs.0000000000000015

Cited by 31 publications

(17 citation statements)

References 66 publications

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“…While there are conflicting reports and immunosuppression regimens employed may also play a role, it appears that infection may also be a triggering factor for vasculopathy. This may be important in VCA as CMV reactivation/infection has been commonly reported and in some cases was difficult to manage . However, in the majority of cases, including VCA patients at our center, the CMV viremia responded well to treatment and was cleared.…”

Section: Tissue Components Of Composite Allograftsmentioning

confidence: 79%

Immunobiology in VCA

et al. 2016

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SUMMARYTransplantation of vascularized composite tissue is a relatively new field that is an amalgamation of experience in solid organ transplantation and reconstructive plastic and orthopedic surgery. What is novel about the immunobiology of VCA is the addition of tissues with unique immunologic characteristics such as skin and vascularized bone, and the nature of VCA grafts, with direct exposure to the environment, and external forces of trauma. VCAs are distinguished from solid organ transplants by the requirement of rigorous physical therapy for optimal outcomes and the fact that these procedures are not lifesaving in most cases. In this review, we will discuss the immunobiology of these systems and how the interplay can result in pathology unique to VCA as well as provide potential targets for therapy.

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Section: Tissue Components Of Composite Allograftsmentioning

confidence: 79%

Immunobiology in VCA

et al. 2016

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“…CMV infection has been documented in face transplantation, especially in high-risk matches (i.e. donor-positive/recipientnegative) [29][30][31][32] Three of our patients had high-risk CMV mismatched donors and experienced primary CMV infection several months after transplant ( Table 3). Others have treated CMV infection in face transplant recipients with valganciclovir, foscarnet, or investigational drug CMX001.…”

Section: Donor Serologymentioning

confidence: 92%

A Single Center's Experience with Donation of Facial Allografts for Transplantation

Huang

Bueno

Pomahač

2015

Vascularized Composite Allotransplantation

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Purpose: Face transplantation offers superior functional and aesthetic outcomes when compared with conventional reconstruction. Optimizing criteria to match donors and recipients will improve outcomes. However, there is limited available literature regarding donor procurement and matching. Methods: The Brigham and Women's Hospital describes its experience with facial allograft donation for 7 face transplants performed between 2009 and 2014. Important considerations include donors' type of death, allograft ischemia time, demographics, immunologic compatibility, serology, and donor facial restoration. Results: Brain-dead, heart-beating donors were preferred because their hemodynamic stability facilitated procurement logistics. The maximum allograft ischemia time allowed by our team was 4 hours. Donor and recipient should be matched in appearance by having the same gender, similar age, and comparable skin tone/texture. Immunologic compatibility requires ABO compatibility, suitable HLA typing, and negative crossmatch. Donor serology for infectious diseases, especially cytomegalovirus (CMV) and Epstein-Barr virus (EBV), is important because of implications of post-transplant immunosuppression. High-risk CMV and EBV matches (donor-positive/ recipientnegative) should be avoided when possible. Facial restoration with a prosthetic mask was performed to preserve the donor's dignity. Conclusions: Although every face transplant recipient has unique needs, the authors hope that sharing their institution's experience with facial allograft donor characteristics will help other face transplant centers and guide future regulation of facial composite allograft donation.

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“…The mucosal tissue of facial VCAs exposes the recipient to donor-derived pathogens, including streptococci, Candida species, and anaerobes. 91 Thus, nasal cultures from VCA recipients displaying methicillin-sensitive Staphylococcus aureus, Pseudomonas aeruginosa, and Pseudomonas pneumoniae have been reported. 88 Fungal infections at surgical sites have been shown once recipients continue with daily activities exposing them to the environmental flora.…”

Section: Immunosuppression: Balancing Risks and Benefitsmentioning

confidence: 99%

“…88 Fungal infections at surgical sites have been shown once recipients continue with daily activities exposing them to the environmental flora. 91 However, the incidence of invasive candida infections has been low. 92 Opportunistic infections specifically associated with face transplantation include superinfected sialocele and parotitis due to remaining donor salivary gland tissue, which can be successfully treated with botulinum toxin injections.…”

Section: Immunosuppression: Balancing Risks and Benefitsmentioning

confidence: 99%