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Sun J(A, Adil A, Biniazan F, Haykal S. Immunogenicity and tolerance induction in vascularized composite allotransplantation. FRONTIERS IN TRANSPLANTATION 2024; 3:1350546. [PMID: 38993748 PMCID: PMC11235364 DOI: 10.3389/frtra.2024.1350546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 07/13/2024]
Abstract
Vascularized composite allotransplantation (VCA) is the transplantation of multiple tissues such as skin, muscle, bone, nerve, and vessels, as a functional unit (i.e., hand or face) to patients suffering from major tissue trauma and functional deficits. Though the surgical feasibility has been optimized, issues regarding graft rejection remains. VCA rejection involves a diverse population of cells but is primarily driven by both donor and recipient lymphocytes, antigen-presenting cells, macrophages, and other immune as well as donor-derived cells. In addition, it is commonly understood that different tissues within VCA, such as the skin, elicits a stronger rejection response. Currently, VCA recipients are required to follow potent and lifelong immunosuppressing regimens to maximize graft survival. This puts patients at risk for malignancies, opportunistic infections, and cancers, thereby posing a need for less perilous methods of inducing graft tolerance. This review will provide an overview of cell populations and mechanisms, specific tissue involved in VCA rejection, as well as an updated scope of current methods of tolerance induction.
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Affiliation(s)
- Jiahui (Angela) Sun
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Aisha Adil
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Felor Biniazan
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Siba Haykal
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Triptolide Reduces the Required Dose of Tacrolimus by Attenuating Inflammation, Enhancing Immunosuppression, and Increasing Donor Chimerism in a Heterotopic Hindlimb Transplantation Model. Plast Reconstr Surg 2016; 138:1243-1253. [DOI: 10.1097/prs.0000000000002770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Ramirez AE, Cheng HY, Lao WW, Wang YL, Wen CJ, Wallace CG, Lin CF, Shih LY, Chuang SH, Wei FC. A novel rat full-thickness hemi-abdominal wall/hindlimb osteomyocutaneous combined flap: influence of allograft mass and vascularized bone marrow content on vascularized composite allograft survival. Transpl Int 2014; 27:977-86. [DOI: 10.1111/tri.12364] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/10/2013] [Accepted: 05/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Alejandro E. Ramirez
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- Pontifical Catholic University of Chile; Santiago Chile
| | - Hui-Yun Cheng
- Center for Vascularized Composite Allotransplantation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - William W. Lao
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- Medical College of Wisconsin; Milwaukee WI USA
| | - Yen-Ling Wang
- Center for Vascularized Composite Allotransplantation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Chih-Jen Wen
- School of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Christopher G. Wallace
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Chih-Fan Lin
- Center for Vascularized Composite Allotransplantation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Ling-Yi Shih
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Sheng-Hao Chuang
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- Center for Vascularized Composite Allotransplantation; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
- School of Medicine; Chang Gung University; Taoyuan Taiwan
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