The Specificity and Management of Vascularized Composite Tissue Allotransplant in Sensitized Recipients

Abstract

Sensitization, a state of the presence of donor-specific antibody (DSA) in recipient, has usually been considered an absolute contraindication to solid organ transplantation including vascularized composite tissue allotransplantation (VCA), due to the antibody-mediated rejection (AMR). However, the role of sensitization in VCA rejection is largely unstudied. We recently reported in a rat model that rejection of VCA was accelerated but not hyperacutely in the presence of allosensitization. The rejection of VCA in sensitized recipients is mainly cellular-mediated as evidenced by dense lymphocytic infiltrates and no antibody deposition in biopsies.