Nonhuman Primate Model of Fibula Vascularized Composite Tissue Allotransplantation Demonstrates Donor-Recipient Bony Union

Mundinger, Gerhard S.; Nam, Arthur J.; Hui-Chou, Helen G.; Stanwix, Matthew G.; Jones, Luke S.; Drachenberg, Cinthia B.; Kukuruga, Debra; Shipley, Steven T.; Dorafshar, Amir H.; Panda, Aruna; Bartlett, Stephen T.; Barth, Rolf N.; Rodriguez, Eduardo D.

doi:10.1097/prs.0b013e318230c5d0

Cited by 30 publications

(17 citation statements)

References 46 publications

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“…Notably, a recent experimental report in nonhuman primates found that BM of a vascularized fibula allograft was completely substituted by recipient cells, and then its facilitating properties for tolerance may be abolished after 6 months. 70 Acute rejection has been identified as a risk factor for graft loss caused by CR after KAT (odds ratio, 7.45, P = 0.01). 6 However, it was not possible to assess this for HAT because there was only 1 graft loss caused by CR.…”

Section: Discussionmentioning

confidence: 97%

Factors Influencing Acute Rejection of Human Hand Allografts

Bonastre¹,

Landín²,

Díez³

et al. 2012

Annals of Plastic Surgery

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Acute rejection (AR) of human hand allografts (HHAs) may carry a risk of graft loss and leads to the need for immunosuppressive treatment. The literature on HHAs was reviewed to determine and evaluate the factors that trigger AR of HHAs. Clinical case reports of hand allograft transplantation published between 1999 and 2011 in English, French, or German were reviewed systematically. The number of AR episodes was the main outcome measure. Sixty-eight episodes of AR were described in 28 recipients. Calcineurin inhibitor-based maintenance regimens were associated with significantly fewer AR episodes than non-calcineurin inhibitor-based regimens (mean 1.9 vs 3.2; P = 0.018). In recipients who experienced cytomegalovirus infection, the mean number of episodes of AR was 4, whereas in those who did not experience cytomegalovirus infection it was 2.25 (P = 0.024). The planning of hand allograft transplantation should take these factors into account to minimize the risk of AR.

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Section: Discussionmentioning

confidence: 97%

Factors Influencing Acute Rejection of Human Hand Allografts

Bonastre¹,

Landín²,

Díez³

et al. 2012

Annals of Plastic Surgery

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“…10 No adjunct induction therapies or corticosteroids were administered, and rejection episodes were not treated with additional therapies to follow the natural clinical course of allograft survival. 8,11 Serial graft biopsies were performed and evaluated by a transplant pathologist as previously described. 5 Immunosuppression was withdrawn in the absence of acute rejection in those animals with graft survival greater than 200 days to evaluate for graft tolerance.…”

Section: Methodsmentioning

confidence: 99%

Infrared Fluorescence Imaging of Lymphatic Regeneration in Nonhuman Primate Facial Vascularized Composite Allografts

Mundinger¹,

Narushima²,

Hui-Chou³

et al. 2012

Annals of Plastic Surgery

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Donor-recipient lymphatic channel regeneration following VCA did not result in resolution of edema. Technical causes of graft edema may be overcome with alternative surgical techniques, allowing for direct investigation of the immunologic relationship between VCA graft edema and rejection responses. Mechanisms and timing of dynamic donor-recipient lymphatic channel relationships can be evaluated using fluorescent imaging systems to better define the immunologic role of lymphatic channels in VCA engraftment and rejection responses, which may have direct clinical implications.

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“…12 Chronic rejection or chronic allograft vasculopathy have not been reported; these disorders were previously considered possible and have become evident in human hand transplantation 44 and preclinical studies. 45 Hyperacute rejection from pre-formed antibodies has also not been reported. Donor-derived macrochimerism has not been reported.…”

Section: Immunological Outcomesmentioning

confidence: 99%

Facial transplantation: the first 9 years

et al. 2014

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Since the fi rst facial transplantation in 2005, 28 have been done worldwide with encouraging immunological, functional, psychological, and aesthetic outcomes. Unlike solid organ transplantation, which is potentially life-saving, facial transplantation is life-changing. This diff erence has generated ethical concerns about the exposure of otherwise young and healthy individuals to the sequelae of lifelong, high-dose, multidrug immunosuppression. Nevertheless, advances in immunomodulatory and immunosuppressive protocols, microsurgical techniques, and computer-aided surgical planning have enabled broader clinical application of this procedure to patients. Although episodes of acute skin rejection continue to pose a serious threat to face transplant recipients, all cases have been controlled with conventional immunosuppressive regimens, and no cases of chronic rejection have been reported.

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Nonhuman Primate Model of Fibula Vascularized Composite Tissue Allotransplantation Demonstrates Donor-Recipient Bony Union

Cited by 30 publications

References 46 publications

Factors Influencing Acute Rejection of Human Hand Allografts

Factors Influencing Acute Rejection of Human Hand Allografts

Infrared Fluorescence Imaging of Lymphatic Regeneration in Nonhuman Primate Facial Vascularized Composite Allografts

Facial transplantation: the first 9 years

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