Nonvascularized human skin chronic allograft rejection

Abstract

| INTRODUC TI ONIn the history of modern transplantation and transplantation immunology, skin grafting has had a special place since the initial scientific studies of T. Gibson and P. Medawar involving human skin allografts during World War II. 1 Indeed, the analysis of human skin allograft rejection in a patient with extensive burns indicated that human tissue rejection was an immunologic phenomenon. These observations were undoubtedly a key stimulus for P. Medawar and others to subsequently develop the entire field of transplantation immunology.Currently, total skin allografts are generally considered vascularized composite allotransplantation (VCA). [2][3][4][5] The normal epidermis has numerous dendritic cells, which play a significant role in rejection. 3 This characterizes the skin as one of the most immunogenic tissues and VCA as one of the most challenging types of allografts, 2,3,5 and skin allografts are virtually always rejected unless adequate long-term immunosuppression is administered. 2,6 With current immunosuppressive regimens, solid organ transplantation (SOT) rejections are currently relatively well controlled, but the development of circulating anti-HLA donor-specific antibody (DSA) in the recipient plays a major role in the late loss of SOT. 7,8 VCA has emerged as a possible option to treat patients who have lost their arms, face, or who have had large body skin defects. 2,9 The management of the recipients after VCA includes skin biopsies, and grades of rejection are diagnosed according to the Banff classification. 10

Healing effect of acellular fish skin with plasma rich in growth factor on full‐thickness skin defects

“…Various types of tissue‐based therapies such as autograft, allograft, and xenograft have been used for this purpose, but none of the methods has been able to meet all the needs of an ideal skin replacement. 12 , 13 Use of the biomaterials as natural scaffolds derived from animals such as bovine and porcine skins have been good alternatives for skin tissue regeneration. 14 , 15 , 16 , 17 Unlike the mentioned mammals' skins, the fish skin as a scaffold for wound healing does not contain prions or viruses that can be transmitted to humans.…”

“…In skin tissue regeneration, the scaffolds act as a temporary extracellular matrix (ECM) for cells, and also a strict barrier against microbes to provoke and propel the process of wound healing. Various types of tissue‐based therapies such as autograft, allograft, and xenograft have been used for this purpose, but none of the methods has been able to meet all the needs of an ideal skin replacement 12,13 . Use of the biomaterials as natural scaffolds derived from animals such as bovine and porcine skins have been good alternatives for skin tissue regeneration 14–17 .…”

Human amniotic membranes as an allogenic biological dressing for the treatment of burn wounds: Protocol for a randomized-controlled study

“…Potential disadvantages of allograft use include rejection und disease transmission [ 11 ]. Skin rejection is likely to occur within 2 weeks after application and is considered inevitable [ 9 , 12 ]. The numerous dendritic cells play a key role in the rejection mechanism and making allogenic skin one of the most immunogenic tissues [ 13 ].…”