Bone infarction of the hip after hand allotransplantation: A case report

Acute Rejection Rates in Vascularized Composite Allografts: A Systematic Review of Case Reports

INTRODUCTION

Vascularized Composite Allografts (VCA) are usually performed in a full major histocompatibility complex mismatch setting, with a risk of acute rejection depending on factors such as the type of immunosuppression therapy and the quality of graft preservation. In this systematic review, we present the different immunosuppression protocols used in VCA and point out relationships between acute rejection rates and possible factors that might influence it.

METHODS

This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We systematically searched Medline (PubMed), Embase, and The Cochrane Library between November 2022 and February 2023, using following Mesh Terms: Transplant, Transplantation, Hand, Face, Uterus, Penis, Abdominal Wall, Larynx, and Composite Tissue Allografts. All VCA case reports and reviews describing multiple case reports were included.

RESULTS

We discovered 211 VCA cases reported. The preferred treatment was a combination of antithymocyte globulins, mycophenolate mofetil (MMF), tacrolimus, and steroids; and a combination of MMF, tacrolimus, and steroids for induction and maintenance treatment, respectively. Burn patients showed a higher acute rejection rate (P = 0.073) and were administered higher MMF doses (P = 0.020).

CONCLUSIONS

In contrast to previous statements, the field of VCA is not rapidly evolving, as it has encountered challenges in addressing immune-related concerns. This is highlighted by the absence of a standardized immunosuppression regimen. Consequently, more substantial data are required to draw more conclusive results regarding the immunogenicity of VCAs and the potential superiority of one immunosuppressive treatment over another. Future efforts should be made to report the VCA surgeries comprehensively, and muti-institutional long-term prospective follow-up studies should be performed to compare the number of acute rejections with influencing factors.

Immunosuppressive strategies in face and hand transplantation: a comprehensive systematic review of current therapy regimens and outcomes

Background

Recipients of Vascularized Composite Allotransplants require effective immunosuppressive therapy to prevent graft rejection. This systematic review summarizes the current body of literature on immunosuppressive regimens used in face and hand transplants while summarizing their outcome in terms of rejection, renal failure, and infections.

Methods

A systematic search of electronic databases was conducted to identify relevant studies from 1998 until July 1st, 2023. We included all studies that discussed immunosuppressive strategies in face and hand transplant recipients according to PRISMA.

Results

The standard triple maintenance therapy was mostly adjusted due to nephrotoxicity or high incidence of rejection. The most common alternative treatments utilized were sirolimus (25/91; 27.5%) or everolimus (9/91; 9.9%) following hand- and photophoresis (7/45; 15.6%), sirolimus (5/45; 11.1%) or belatacept (1/45; 2.2%) following face transplantation. Episodes of rejection were reported in 60 (65.9%) of hand- and 33 (73%) of face transplant patients respectively. Graft loss of 12 (13.2%) hand and 4 (8.9%) face transplants was reported. Clinical CMV infection was observed in 6 (6.6%) hand and 7 (15.5%) face transplant recipients.

Conclusions

Based on the herein presented data, facial grafts exhibited a heightened incidence of rejection episodes and CMV infections. Facial mucosa adds complexity to the immunological graft composition highlighting the need of individualized immunosuppressive regimens and further research.

THE RELATIONSHIP OF CLINICAL AND MORPHOLOGICAL DATA IN COMMINUTED FRACTURES OF THE LOWER JAW

OBJECTIVE

The aim is to establish the relationship between some clinical, physiological and morphological parameters in patients with the consequences of an acute injury considering the features of pathological and reparative changes in the bone fragments of the lower jaw formed during a fracture using clinical and morphological methods.

PATIENTS AND METHODS

Materials and methods: The material of the study was bone fragments of the lower jaw, removed during osteosynthesis operations in 20 patients with traumatic comminuted fractures. Also, the material of the study was the data obtained during the examination of the above patients. Morphological parameters characterizing the state of the fragments tissues removed during surgical treatment of fractures of the lower jaw and clinical parameters characterizing the patient's condition in cases of traumatic fractures of the lower jaw treatment were identified for frequency and correlation analysis. Different of frequency of individual indicators' gradations cases was determined by the χ-square test, correlations between parameters (correlations of pairs of parameters "clinic - morphology", "clinical and laboratory data - morphology") - by calculating the Pearson association coefficient.

RESULTS

Results: The main pathological and reparative changes are determined in the bone fragments of the lower jaw after a traumatic fracture: osteomedullary ischemic necrosis (traumatic bone infarction), nonspecific productive inflammation, endosteal and periosteal bone regenerates. The severity and frequency of pathological and reparative changes in the bone fragments of the lower jaw vary, leading to various correlations between clinical and morphological indicators of the fragment tissues conditions. Reliable correlations were established between individual clinical and morphological indicators of the state of bone fragments corresponding to the values of the association coefficient in the range of 0.3-0.7, in particular: in the pair "age of the patient" - "endosteal regenerates" - the dependence is negative, of medium strength, significant (p<0.05); in the pair "age of the patient" - "periosteal regenerates" - the dependence is negative, of medium strength, significant (p<0.05); in the pair "fragment surface area" - "osteonecrosis" - the relationship is negative, weak, significant with the probability of error in assessing the value |ra| p<0.1; in the pair "locus of a fracture in the lower jaw" - "type of inflammation in the bone marrow" - the dependence is positive, of medium strength, highly reliable (p<0.01).

CONCLUSION

Conclusions: A comprehensive clinical and morphological examination made it possible to calculate quantitative data that characterize the frequency parameters of the occur¬rence of certain pathological changes in the bone fragments of the lower jaw after a fracture and the features of individual clinical and morphological parameters conjugation in patients with the consequences of a mechanical jaw injury. The obtained data on the correlation dependences of the type "clinic - morphology" can be used to predict the severity of morphological parameters according to the known values of clinical parameters in patients with the consequences of mandibular fractures.