Vascularized Composite Allotransplantation最新文献

{"title":"2499: Establishing a novel surgical model for optic nerve repair","authors":"C. Cakmakoglu, B. Gharb, A. Rampazzo, G. Kwiecien, M. Madajka, Addison Barnett, F. Papay","doi":"10.1080/23723505.2016.1234214","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234214","url":null,"abstract":"2499: Establishing a novel surgical model for optic nerve repair Cagri Cakmakoglu, MD, Bahar Bassiri Gharb, MD, PhD, Antonio Rampazzo, MD, PhD, Grzegorz Kwiecien, MD, Maria Madajka, PhD, Addison Barnett, BS, and Francis Papay, MD Cleveland Clinic, Cleveland, OH, USA; Plastic Surgery, Cleveland, OH, USA Background Efforts to transplant a mammalian eye have failed mainly due to the ganglion cell axon’s inability to withstand transection. Eye transplantation is not feasible without proof of optic nerve regeneration. The objective of this pilot study is to find an optimal rat optic nerve transection and repairmodel in preparation for eye transplantation. Methods 30 cadaver and 10 live Lewis rats were used to expose, transect, and repair the optic nerve and visualize its anatomical relationship with the ophthalmic artery. Nerve coaptation was performed with 12/0 suture. The pathway of the ophthalmic artery was evaluated by red latex injection.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"38 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113970244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2594: In vitro and in vivo characterization of human hematopoietic chimeric cells - A novel strategy to induce tolerance in transplantation","authors":"Ewa Bryndza Tfaily, M. Cyran, R. Gendek, E. Szilagyi, Jason L Le, A. Domaszewska-Szostek, J. Cwykiel, M. Siemionow","doi":"10.1080/23723505.2016.1234208","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234208","url":null,"abstract":"2594: In vitro and in vivo characterization of human hematopoietic chimeric cells A novel strategy to induce tolerance in transplantation Ewa Bryndza Tfaily, PhD, Malgorzata Cyran, MD, Rafal Gendek, MD, PhD, Erzsebet Szilagyi, MD, PhD, Jason Le, MD, Anna Domaszewska-Szostek, PhD, Joanna Cwykiel, MSc, and Maria Siemionow, MD, PhD, DSc University of Illinois at Chicago, Chicago, IL, USA; Polish Academy of Science, Warszawa, Poland Background Cell-based therapies represent a new promising approach for tolerance induction in transplantation One of the methods for immune response modulation in solid organ and vascularized composite allograft (VCA) recipients is donor bone marrow (BM) transplantation We propose a new cellular therapy based on application of the ex vivo created donor-recipient chimeric cells as an alternative approach to BM-based therapies in support of solid organ and VCA transplantation The aim of this study was further characterization of human hematopoietic chimeric cells (HHCC).","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121336993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2578: Improved vascularized composite allograft survival in sensitized rats after syngeneic hematopoietic stem cell transplantation and fludarabine","authors":"Howard D. Wang, S. Fidder, Devin Miller, G. Furtmuller, D. Lough, Joseph Lopez, A. Quan, J. Budihardjo, G. Raimondi, Zhaoli Sun, W. Lee, G. Brandacher","doi":"10.1080/23723505.2016.1233023","DOIUrl":"https://doi.org/10.1080/23723505.2016.1233023","url":null,"abstract":"2578: Improved vascularized composite allograft survival in sensitized rats after syngeneic hematopoietic stem cell transplantation and fludarabine Howard D. Wang, MD, Samuel Fidder, MD, Devin Miller, MD, Georg Furtmuller, MD, Denver M. Lough, MD, PhD, Joseph Lopez, MD, MBA, Amy Quan, MPH, Joshua Budihardjo, Giorgio Raimondi, PhD, Zhaoli Sun, MD, PhD, W. P. Andrew Lee, MD, and Gerald Brandacher, MD Johns Hopkins University School of Medicine, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, MD, USA Background Vascularized composite allotransplantation (VCA) is a promising option for patients with devastating injuries from severe burn or trauma The initial management of this patient population frequently requires blood transfusions or skin allografts, leading to formation of alloantibodies and a high degree of sensitization Sensitized recipients are at risk for antibody-mediated rejection (AMR) and poor graft outcomes Our group has established a model of AMR in sensitized rats and demonstrated accelerated rejection of the hind-limb allograft The aim of this study is to establish a desensitization protocol using haematopoietic stem cell transplantation (HSCT) to prevent AMR in the setting of VCA. Methods Sensitization was established by performing skin transplants from Dark Agouti (DA) donors to Lewis rat recipients Sensitized controls received skin transplant only, whereas the experimental group underwent a desensitization protocol including a 7-day course of fludarabine, myeloablative total body irradiation (12Gy) and syngeneic HSCT Serum donor specific antibody (DSA) levels of both groups were measured using flow cytometry after skin transplant and again after desensitization Orthotopic hind-limb transplantation from DA donors was then performed, and daily tacrolimus (05 mg/kg) was administered thereafter Graft rejection was defined as grade 3 rejection and was assessed by clinical monitoring and histology Complement deposition was examined by performing immunohistochemistry for C4d.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115421255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2563: Non-contrast enhanced 7 tesla MR imaging for non-invasive monitoring of chronic rejection in reconstructive transplantation","authors":"Shailesh B Raval, T. Zhao, Narayanan Krishnamurthy, T. Ibrahim, V. Gorantla","doi":"10.1080/23723505.2016.1233014","DOIUrl":"https://doi.org/10.1080/23723505.2016.1233014","url":null,"abstract":"2563: Non-contrast enhanced 7 tesla MR imaging for non-invasive monitoring of chronic rejection in reconstructive transplantation Shailesh Raval, MS, Tiejun Zhao, PhD, Narayan Krishnamurthy, Tamer Ibrahim, PhD, and Vijay S. Gorantla, MD, PhD University of Pittsburgh, Pittsburgh, PA, USA; Siemens Healthineers, Malvern, PA, USA Introduction Chronic rejection (CR) in solid organ and reconstructive transplantation (RT) is associated with progressive, occlusive intimal hyperplasia (IH) resulting in ischemic graft loss Four hand transplants and 1 face transplant have been lost to CR Skin biopsies can detect acute rejection (AR) but miss CR changes Early detection is key to prevent CR graft loss Sequential vascular mapping with CT angiography is fraught with radiation/contrast risks and intravascular imaging is invasive or lead to graft ischemia For the first time, we developed a non-invasive, reliable and reproducible, non-radiation, contrast-free, ultra-high resolution (UHR) 3D vascular MRI imaging strategy for preoperative (surgical planning) and perioperative (graft viability) and post-transplant (CR monitoring) applications in RT. Results Our non-contrast technique allowed UHR luminal and vessel wall imaging in the CF and UE tissues Volume-rendering and post-processing allowed successful 3D-reconstruction and segmenting micro/macrovasculature of CF and UE without skeletonization or dilation Figure 1 summarizes T1-VIBE, T2-DESS and DSI revealing exquisite detail of soft tissue anatomy (vessels, muscles, nerve, fat, ligaments, and tendons). Conclusion Current state of the art imaging in RT includes conventional imaging (3D-CT, 15/3TMRI, CT-angio, intravascular-ultrasound, plain-radiography) and stereolithography for surgical planning with limitation like radiation, renal toxic contrast or are of sub-optimal resolution to map microvessels /other structures Our approach is renal-toxic-contrast and radiationfree, increasing its safety in RT (CF or UE) or even solid organ (eg renal transplant) applications for sequential non-invasive graft monitoring of CR In addition, UHR imaging can be used for monitoring of neuroregeneration after transection/repair or transplant related nerve outcomes as well as identifying precise localization of various structures for patient screening/selection, procedural planning and sequential monitoring of macro/microvascular parameters. CONTACT Shailesh Raval, MS rshailesh8504@gmail.com Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/kvca. © 2016 Shailesh Raval, Tiejun Zhao Tiejun Zhao, Narayan Krishnamurthy, Tamer Ibrahim, and Vijay S. Gorantla. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"217 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116419833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2579: Face transplantation and the reconstructive management of the self-inflicted gunshot wound: An aesthetic, functional, and psychosocial report of 6 clinical cases","authors":"H. Kiwanuka, M. Aycart, D. Gitlin, Elaine Devine, B. Perry, T. Win, E. Bueno, M. Alhefzi, N. Krezdorn, B. Pomahac","doi":"10.1080/23723505.2016.1234240","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234240","url":null,"abstract":"2579: Face transplantation and the reconstructive management of the self-inflicted gunshot wound: An aesthetic, functional, and psychosocial report of 6 clinical cases Harriet Kiwanuka, Mario A. Aycart, MD, David Gitlin, MD, Elaine Devine, LICSW, Bridget Perry, MS, Thet Su Win, MD, PhD, Ericka M. Bueno, Muayyad Alhefzi, Nicco Krezdorn, and Bohdan Pomahac, MD Brigham and Women’s Hospital, Boston, MA, USA; Mass General Institute of Health Professions, Boston, MA, USA Background Self-inflicted gunshot wounds to the face cause devastating midfacial defects, and pose a challenge to the reconstructive surgeon Face transplantation has the potential to provide near-normal restoration in otherwise non-reconstructable defects Two out of 7 face transplant recipients at our institution had sustained self-inflicted gunshot wounds We illustrate the role of face transplantation in the management of self-inflicted gunshot wounds through an aesthetic, functional, and psychosocial examination of outcomes. Methods We performed a retrospective analysis of individuals with self-inflicted gunshot wounds who were screened for inclusion in our face transplantation protocol between 2008 and 2015. We collected data describing the patients’ injuries, modes of conventional reconstruction, and deficits thereafter For those who received face transplants, we critically reviewed the psychosocial screening process and post-transplantation aesthetic, functional, and psychosocial outcomes. Results Six individuals postself-inflicted gunshot wounds were screened for face transplantation All had undergone conventional reconstruction, with 5 receiving loco-regional flaps and free tissue transfers, and one undergoing serial debridement and primary soft tissue repair All suffered from residual functional and aesthetic deficits Two underwent partial face transplantation at our center and one is currently undergoing screening We describe the pre-transplant psychosocial screening process and the aesthetic, functional, and psychosocial outcomes of the self-inflicted gunshot wound transplant recipients. Conclusions We examined the injury imparted by self-inflicted gunshot wounds to the face, outcomes of conventional reconstruction, and how face transplantation offers a potentially superior solution. More importantly, we highlight the critical nature of the psychosocial component of the multidisciplinary evaluation given the history of mental illness and suicidal behavior in this subset of patients CONTACT Harriet Kiwanuka hkiwanuka@partners.org Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/kvca. © 2016 Harriet Kiwanuka, Mario A. Aycart, David Gitlin, Elaine Devine, Bridget Perry, Thet Su Win, Ericka M. Bueno, Muayyad Alhefzi, and Bohdan Pomahac. Published with license by Taylor & Francis. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons.org/lic","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129437556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2552: Toward tolerance of facial allotransplantation: Preliminary results in a non-human primate model with tocilizumab","authors":"Z. Ng, A. Lellouch, M. DeFazio, Zachary W. Heroux, Ilse M. Schol, J. Kurtz, C. Cetrulo","doi":"10.1080/23723505.2016.1232988","DOIUrl":"https://doi.org/10.1080/23723505.2016.1232988","url":null,"abstract":"2552: Toward tolerance of facial allotransplantation: Preliminary results in a non-human primate model with tocilizumab Zhi Yang Ng, MD, Alexandre G. Lellouch, MD, Matthew W. Defazio, BS, Zachary W. Heroux, BS, Ilse Schol, BS, Josef M. Kurtz, PhD, and Curtis L. Cetrulo, Jr., MD, FACS, FAAP Massachusetts General Hospital, Boston, MA, USA Background Tocilizumab (anti-IL-6 receptor mAb) is currently FDA approved for use in idiopathic and rheumatoid arthritis. It mitigates inflammation, reduces the incidence of GvHD, and promotes regulatory T-cell proliferation We investigated its utility in a non-human primate model (NHP) of facial VCA to achieve prolonged survival and/or tolerance in reconstructive transplantation. Methods Facial allografts were transplanted into MHC-mismatched NHPs (n D 4) after ATGAM induction, maintained post-operatively with FK506, MMF and methylprednisolone, before further conditioning (irradiation, lymphocyte depletion) in preparation for donor bone marrow transplantation (DBMT) on POD 60 Tocilizumab was administered on the day of DBMT, and at weekly intervals thereafter for a total of 5 doses Post-DBMT, recipients received a tapering course of cyclosporine-A with complete withdrawal 28 d later VCA was assessed by serial clinical examination and histopathology; chimerism was monitored by flow cytometry and in vitro immunologic responses were measured with CFSE mixed lymphocyte reaction (MLR) assays. Results Prior to DBMT, up to 2 episodes of acute skin rejection (AR) developed and required additional steroid bolus treatment Two recipients had to be euthanized within 2 weeks post-DBMT due to lung infection from neutropenic sepsis and disseminated post-transplant lymphoproliferative disorder (PTLD) respectively but VCAs remained AR-free up to experimental end point Of the remaining 2 recipients, one has just been withdrawn from immunosuppression while the other was off for 36 d before AR developed No evidence of mixed chimerism was detected but in vitro assays demonstrate decreased anti-donor responses after DBMT, which remains up to this time To date, no systemic sequelae of GvHD or PTLD have been observed at up to POD 205. Conclusions As with the clinical experience in patients treated with tocilizumab, vigilant monitoring is required following drug administration due to increased susceptibility to infection and neutropenia Anti-IL-6 blockade appears to promote shortmedium term immunosuppression-free VCA survival in this NHP model Continued follow-up is required to determine if long-term transplantation tolerance of the VCA has been achieved Of particular clinical concern is the development of PTLD following tolerance induction Further investigations are underway to optimize and develop a safe VCA tolerance protocol for clinical application. CONTACT Zhi Yang Ng zyng@mgh.harvard.edu © 2016 Zhi Yang Ng, Alexandre G. Lellouch, Matthew W. Defazio, Zachary W. Heroux, Ilse Schol, Josef M. Kurtz, and Curtis L. Cetrulo, Jr. Published","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129299160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2553: Measuring functional recovery after chronic denervation of peripheral nerves: A novel rat forelimb model","authors":"A. Quan, Joseph Lopez, J. Budihardjo, S. Mermulla, T. Jawadi, Howard D. Wang, A. Hoke, S. Tuffaha, W. Lee, G. Brandacher","doi":"10.1080/23723505.2016.1234233","DOIUrl":"https://doi.org/10.1080/23723505.2016.1234233","url":null,"abstract":"2553: Measuring functional recovery after chronic denervation of peripheral nerves: A novel rat forelimb model Amy Quan, Joseph Lopez, Joshua Budihardjo, Sara Mermulla, Tariq Jawadi, Howard Wang, Ahmet Hoke, Sami Tuffaha, W. P. Andrew Lee, and Gerald Brandacher Johns Hopkins University School of Medicine, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, MD, USA Background Functional outcomes after vascularized composite allotransplantation (VCA) depend on nerve regeneration. After transplantation, the recipient peripheral nerve axons slowly grow and reinnervate the graft. Meanwhile, the target composite tissues (i.e., muscle, nerves) are chronically denervated, causing significant damage to axons, Schwann cells, and muscle, which leads to decreased nerve regeneration potential. There are currently no studies that reliably measure the effects of chronic denervation (CD) on graft function. Thus, we have developed a novel nerve injury rat model that optimizes the measurement of functional recovery after CD. Methods In our forelimb chronic denervation model, the median nerve was transected at the mid-humerus level and left in discontinuity for 0, 8, or 12 weeks. After the period of CD, the distal median nerve stump was coapted to the proximal end of a freshly axotomized ulnar nerve. Group 1 rats underwent 8 weeks of CD (n D 8); Group 2 underwent 12 weeks of CD (n D 8); Group 3 (positive control) did not undergo CD but instead underwent immediate ulnar-median neurorrhaphy (n D 8); and Group 4 (naive control) did not undergo any surgery (nD 8). Functional recovery was monitored weekly by measuring grip strength, feeding ability, and compound muscle action potentials (CMAPs) in median nerve-innervated muscles. Animals were sacrificed at 14 weeks after ulnar-median neurorrhaphy for assessment of axonal regeneration and degree of muscle atrophy.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"227 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123466751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2587: Vascularized composite allotransplantation combined with donor bone marrow and post transplantation high-dose cyclophosphamide (PTCy) induces immune tolerance after reconstructive transplantation","authors":"G. Furtmuller, B. Oh, Madeline L. Fryer, J. Dodd-o, S. Ganguly, G. Raimondi, D. Cooney, W. Lee, L. Luznik, G. Brandacher","doi":"10.1080/23723505.2016.1233036","DOIUrl":"https://doi.org/10.1080/23723505.2016.1233036","url":null,"abstract":"2587: Vascularized composite allotransplantation combined with donor bone marrow and post transplantation high-dose cyclophosphamide (PTCy) induces immune tolerance after reconstructive transplantation Georg J. Furtmuller, MD, Byoung Chol Oh, DVM, PhD, Madeline Fryer, BS, Jeffrey Dodd-o, MD, PhD, Sudipto Ganguly, PhD, Giorgio Raimondi, PhD, Damon Cooney, MD, PhD, W. P. Andrew Lee, MD, Leo Luznik, MD, and Gerald Brandacher, MD Johns Hopkins University School of Medicine, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, MD, USA; Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Background Reconstructive transplantation has become an enthusiastically employed means for reconstruction of devastating tissue defects However, conventional immunosuppression required to maintain allograft survival hinders its widespread application The treatment concept presented here is designed to induce immunosuppression-free allograft survival Methods: Murine skin, heart, and hindlimb transplants were performed across a full MHC mismatch barrier Recipients were treated with PTCy (ie non-myeloablative TBI, T-cell depletion and a single dose of post-transplant cyclophosphamide) with and without donor BM and splenocytes (DBM) Mixedand regulatory T cell chimerism as well as Vb-TCRstaining was performed Donor-specific unresponsiveness was tested via mixed lymphocyte reactions (MLR) and by secondary skin and heart transplant challenge. Results Untreated animals rejected allogeneic skin grafts, hearts and hindlimbs acutely within 14 § 1 days, 9 §2 days, and 8 § 1 days, respectively The PTCy extended skin and heart graft survival (32 § 8; 65 § 4 days, respectively) Additional DBM augmentation lead to allograft survival of >150 days in skin and heart Indefinite graft survival of >250 days was observed in all animals receiving the induction regimen and a VCA § DBM In groups receiving a VCA with and without DBM, donor chimerism was detected at 3017% § 872% and 2251% § 596%, respectively Regulatory T cell chimerism showed recipient-derived Tregs predominantly contributing to the Treg pool (926C/¡ 42%) in the early phase after transplantation (POD 14–30) whereas at later time points (POD 60-100) donor-derived Foxp3C cells contributed equally (462 C/¡ 113%). Gradual depletion of developing T cell clones by donor-derived cells, shown by progressive reduction in circulating Vb5/11C T cells, indicates actuation of central mechanism for tolerance induction All long-term survivors showed donor-specific T cell unresponsiveness invitro (MLR) while demonstrated proliferation against 3rd party stimulators In-vivo, tolerant animals rejected 3rd party skin while donor-matched tissues were accepted long-term (skin and heart). Conclusion Robust tolerance and immunosuppression-free long-term allograft survival can be induced combining DBM transplantation with PTCy in a fully MHC-mismatched murine models of skin, heart, and VCA The intragraft vascul","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125385887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2589: Heterotopic rat penis transplantation: A novel microsurgical model to study distinct immunologic features of urogenital tissues in the setting of reconstructive transplantation","authors":"S. Fidder, G. Furtmuller, B. Oh, B. Kern, D. Lough, W. Lee, D. Cooney, R. Redett, G. Brandacher","doi":"10.1080/23723505.2016.1233037","DOIUrl":"https://doi.org/10.1080/23723505.2016.1233037","url":null,"abstract":"2589: Heterotopic rat penis transplantation: A novel microsurgical model to study distinct immunologic features of urogenital tissues in the setting of reconstructive transplantation Samuel A. J. Fidder, BS, Georg J. Furtmuller, MD, Byoung Chol Oh, DVM, PhD, Barbara Kern, MD, Denver M. Lough, MD, PhD, W. P. Andrew Lee, MD, Damon S. Cooney, MD, PhD, Richard J. Redett, MD, and Gerald Brandacher, MD Johns Hopkins University School of Medicine, Vascularized Composite Allotransplantation (VCA) Laboratory, Baltimore, MD, USA Background Defects of the male urogenital structures are associated with impaired sexual function and a significantly reduced quality-of-life. Modern reconstructive methods employ autologous tissue-based reconstructions and implant placement to reconstruct a functional phallus. Penis transplantation has been successfully employed in the recent past and represents an exciting avenue for restoration of male urogenitalia and function by using “likewith-like” tissue. This animal model is designed to fill a critical void as only little is known on the immunology of these unique tissue grafts. Methods In male 8-week old BN & Lewis rats the penis was dissected to design a penile graft based on the internal pudendal artery and dorsal penile vein including the skin of the prepuce. The non-suture cuff technique was employed to perform end-toend anastomosis of the graft vessels to the recipient inferior epigastric vessels. Syngeneic and allogeneic transplants were performed Native and graft penile tissue were obtained at various time points for histologic analysis. Results Graft design yields suitable caliber and length of graft vessels at the radix of the penis. Anastomosis of the dorsal penile vein and the distal internal pudendal artery at the bifurcation into dorsal and deep penile arteries ensures optimal perfusion of the entire superficial and deep graft tissues. The non-suture cuff technique allows for successful microvascular anastomosis by a single surgeon in an average of 25 hours. Longterm graft survival (>30 days) was observed in syngeneic transplants (N D 3). To date, allogeneic transplant combinations from BN to Lewis rats have been performed and tissues have been harvested for analysis at various time points (ie POD 3, 5, 7, 9, 11; ND 5). Conclusion We have been able to establish a robust and reproducible murine model to study the unique immunobiology of urogenital tissue in the context of reconstructive transplantation. The design of the graft ensures optimal vascular perfusion of superficial and deep penile tissues. Heterotopic inset further allows for visual monitoring of graft viability, while the native penis serves an optimal control. The graft design includes the dorsal penile nerve and may thus be a platform for studies on erectile tissues and function. CONTACT Gerald Brandacher, MD gbrandacher@jhmi.edu © 2016 Samuel A. J. Fidder, Georg J. Furtmuller, Byoung Chol Oh, Barbara Kern, Denver M. Lough, W. P. Andrew Lee, Damo","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126212137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in peripheral nerve regeneration as it relates to VCA","authors":"M. Suchyta, M. Sabbagh, M. Morsy, S. Mardini, S. Moran","doi":"10.1080/23723505.2017.1344347","DOIUrl":"https://doi.org/10.1080/23723505.2017.1344347","url":null,"abstract":"ABSTRACT Vascularized composite allotransplant (VCA) offers functional, social, and quality of life improvements for patients who have exhausted traditional reconstructive options. Unlike solid organ transplant, VCA success is not only based upon the quality of perfusion and level of immunosuppression, but also on the success of nerve regeneration within the transplanted part. This paper will summarize the present state of peripheral nerve regeneration in the context of VCA and will explore the latest research advances that will affect the future of the field. These advances offer promising future strategies to improve patient outcomes in VCA.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128872004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}