Vascularized Composite Allotransplantation最新文献_第7页

Reconstruction for All: The Case for Pediatric Hand Transplantation 所有人的重建:儿童手部移植的案例

Vascularized Composite Allotransplantation Pub Date : 2015-07-03 DOI: 10.1080/23723505.2015.1133268

David L. Colen, Jonathan Bank, Christine McAndrew, L. Levin

{"title":"Reconstruction for All: The Case for Pediatric Hand Transplantation","authors":"David L. Colen, Jonathan Bank, Christine McAndrew, L. Levin","doi":"10.1080/23723505.2015.1133268","DOIUrl":"https://doi.org/10.1080/23723505.2015.1133268","url":null,"abstract":"The advent of vascularized composite allotransplantation (VCA) has ushered in a new era of reconstructive surgery. Lower rungs on the reconstructive ladder rely on autologous tissue, alloplastic materials and pretreated biologics to reconstruct and mimic the functional and aesthetic components of human anatomy. VCA, however, uniquely provides the exact functional components in the appropriate anatomic configuration to restore both form and function together in a single unit. Following the first successful hand transplant in 1998, the medical community has progressively adopted VCA as a viable restorative option for a multitude of functional defects. Reconstructive Hand Transplantation (RHT) remains the most commonly practiced form of VCA and to date, 72 patients in 16 countries have undergone transplantation of 107 upper extremities over the past 17 y. As this field continues to gain traction and enjoy advances in transplant medicine, it is time we consider pediatric recipients who may have more to gain from our efforts. Noncompliance with immunosuppression and hand therapy may impede outcomes; yet, with proper patient selection and adequate familial and social support we can restore a sense of wholeness and normalcy to our children who have suffered limb loss.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125185829","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}

引用次数: 8

Chest Wall, Thymus, and Heart Transplant: Pushing the Boundary of Solid Organ and Vascularized Composite Allotransplantation 胸壁、胸腺和心脏移植:推动实体器官和血管化复合异体移植的界限

Vascularized Composite Allotransplantation Pub Date : 2015-04-03 DOI: 10.1080/23723505.2015.1081716

G. Torregrossa, M. Sosin, G. Gerosa, S. Tuffaha, L. Gottlieb, M. Christy, A. Dorafshar

{"title":"Chest Wall, Thymus, and Heart Transplant: Pushing the Boundary of Solid Organ and Vascularized Composite Allotransplantation","authors":"G. Torregrossa, M. Sosin, G. Gerosa, S. Tuffaha, L. Gottlieb, M. Christy, A. Dorafshar","doi":"10.1080/23723505.2015.1081716","DOIUrl":"https://doi.org/10.1080/23723505.2015.1081716","url":null,"abstract":"Background: The purpose of this study is to design a proof-of-concept cadaveric model to describe technical aspects of allograft harvest and recipient inset of an en bloc chest wall, thymus, and heart transplant. Materials and Methods: Two surgical simulations were performed involving procurement and inset. Four cadavers were obtained and identified as donor or recipient. Debriefing following each simulation addressed technical feasibility, anatomical considerations, degree of difficulty, length of surgery, and formulating a bailout strategy. An intraoperative vascular dye perfusion study was performed to determine the vascular territories of the chest wall and the need for bilateral arterial inflow to the chest. Results: Both transplant procedures were successfully completed. Mean donor age was 88.5 y old (range: 83–94). Allograft harvest mean duration was 94.5 minutes (range: 89–100). Graft inset duration was 90.5 minutes (range: 88–93), with a mean duration of 33 minutes (range: 25–41) of chest wall fixation. The right and left IMA, each demonstrated ipsilateral colored staining of the chest wall, without evidence of dye crossing midline. Strong skin and muscle staining was observed with moderate staining of bone. Conclusion: This cadaveric surgical simulation supports the en bloc chest wall, thymus, and heart transplant to be technically feasible for clinical application.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"363 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116360551","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}

引用次数: 3

Lower Extremity Allotransplantation: Are We Ready for Prime Time? 下肢异体移植:我们准备好进入黄金时代了吗?

Vascularized Composite Allotransplantation Pub Date : 2015-04-03 DOI: 10.1080/23723505.2015.1123798

E. Swanson, Hsu-Tang Cheng, D. Lough, W. Lee, J. Shores, G. Brandacher

{"title":"Lower Extremity Allotransplantation: Are We Ready for Prime Time?","authors":"E. Swanson, Hsu-Tang Cheng, D. Lough, W. Lee, J. Shores, G. Brandacher","doi":"10.1080/23723505.2015.1123798","DOIUrl":"https://doi.org/10.1080/23723505.2015.1123798","url":null,"abstract":"With the success of upper extremity and face transplantation, the field of vascularized composite allotransplantation (VCA) is preparing to expand into other reconstructive areas of the body. Lower extremity allotransplantation has the potential to offer patients improved function over current prosthetics, reduce phantom limb pain, and reduce prosthetic associated complications. However, these benefits must be weighed against the obstacles of slow-paced nerve regeneration, difficult perioperative management, and lifelong immunosuppression. Four cases of lower extremity transplantation have been performed with increasingly high-risk operations, marked by deaths of the last 2 recipients. As lower extremity allotransplantation proceeds, selecting the appropriate candidates to optimize outcomes is critical. We propose a classification system of lower extremity allotransplantation based on the extent of preservation of recipient muscular innervation and detail a practical next recipient. If a safe and thoughtful approach is taken, we believe lower extremity allotransplantation can achieve similarly positive results to those seen in hand and face allotransplantation.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133326413","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}

引用次数: 8

Proximal Forearm Transplantation for Below Elbow Amputations: Rationale and Surgical Technique 前臂近端移植治疗肘部以下截肢:基本原理和手术技术

Vascularized Composite Allotransplantation Pub Date : 2015-01-02 DOI: 10.1080/23723505.2015.1068909

B. McClelland, S. Mccabe, S. Haykal, G. Borschel, R. Zuker, L. Levin

引用次数: 2

Differentiation Between Vascularized Composite Allograft Acute Skin Rejection and Delayed Type Hypersensitivity Reactions Based on Cytokine Analysis 基于细胞因子分析的血管化复合同种异体移植急性皮肤排斥反应与延迟型超敏反应的鉴别

Vascularized Composite Allotransplantation Pub Date : 2015-01-02 DOI: 10.1080/23723505.2015.1044636

D. Wolfram, H. Hackl, N. Eberhart, T. Hautz, R. Starzl, Nikolaus Thuille, Tanja Wachter, B. Zelger, G. Pierer, S. Schneeberger

{"title":"Differentiation Between Vascularized Composite Allograft Acute Skin Rejection and Delayed Type Hypersensitivity Reactions Based on Cytokine Analysis","authors":"D. Wolfram, H. Hackl, N. Eberhart, T. Hautz, R. Starzl, Nikolaus Thuille, Tanja Wachter, B. Zelger, G. Pierer, S. Schneeberger","doi":"10.1080/23723505.2015.1044636","DOIUrl":"https://doi.org/10.1080/23723505.2015.1044636","url":null,"abstract":"Background: Skin rejection in vascularized composite allotransplantation is a major hurdle for wider clinical adoption in VCA. Histopathological alterations during acute skin rejection mimic inflammatory skin processes and are difficult to differentiate. The aim of this study was to identify protein expression patterns characteristic for acute skin rejection in reference to inflammatory skin processes, such as delayed type hypersensitivity reactions. Methods: Limb transplantations were performed using a Brown-Norway to Lewis rat allotransplant model. For the induction of skin inflammation a contact hypersensitivity (CHS) and delayed type hypersensitivity (DTH) model in Lewis rats were established. CHS and DTH result in skin irritation and swelling comparable to grade I-II rejection in our rat allotransplant model. While the DTH reaction is limited to the plantar skin, the CHS model allows for comparison with rejection also in hairy skin. Skin biopsies were taken at defined time points, where a histologically identical inflammatory response in all study groups was present. Protein levels of 14 inflammatory cytokines were assessed by Luminex™. Results: Based on the multivariate linear discriminant analysis, IL-12p70 and TNF-α were the major discriminators between skin rejection and inflammatory skin reactions. Principal component analysis identified IL-1α, GM-CSF, IL-6 and IL-18 as key drivers of rejection at this time point. Conclusion: The novel diagnostic platform enables for early and specific diagnosis of rejection and differentiation toward inflammatory skin diseases in this transplant model.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121907825","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}

引用次数: 0

Effects of Transient Donor Chimerism on Rejection of MHC-Mismatched Vascularized Composite Allografts in Swine 短暂供体嵌合对猪mhc不匹配复合同种异体血管移植排斥反应的影响

Vascularized Composite Allotransplantation Pub Date : 2015-01-02 DOI: 10.1080/23723505.2015.1039692

Angelo A Leto Barone, J. Kurtz, A. Albritton, C. Mallard, K. Shanmugarajah, Radbeh Torabi, D. Leonard, M. Randolph, Christene A. Huang, D. Sachs, C. Cetrulo

{"title":"Effects of Transient Donor Chimerism on Rejection of MHC-Mismatched Vascularized Composite Allografts in Swine","authors":"Angelo A Leto Barone, J. Kurtz, A. Albritton, C. Mallard, K. Shanmugarajah, Radbeh Torabi, D. Leonard, M. Randolph, Christene A. Huang, D. Sachs, C. Cetrulo","doi":"10.1080/23723505.2015.1039692","DOIUrl":"https://doi.org/10.1080/23723505.2015.1039692","url":null,"abstract":"Background: Despite encouraging outcomes in vascularized composite allograft (VCA) transplantation, the risks of chronic immunosuppression limit widespread applicability. It has been suggested that infusion of donor bone marrow along with the VCA may reduce the level of immunosuppression required to prevent clinical VCA rejection. However, no clear evidence has yet been presented to confirm the role of donor bone marrow in the prevention of rejection. In this study we investigated the immunologic effects of concurrent bone marrow transplantation in a large animal VCA model. Methods: MGH miniature swine (n=4) received a non-myeloablative conditioning regimen consisting of low-dose total body irradiation, T-cell depletion, a short course of Cyclosporine A, with or without varying doses of donor bone marrow cells in combination with a complete MHC-mismatched VCA. Animals were monitored daily for signs of rejection or graft versus host disease. Chimerism levels were assessed using flow cytometry and in vitro assays were performed to assess for donor-specific responses. Results: Transient chimerism was prolonged with increased bone marrow cell doses and total body irradiation. While animals that received BMC infusions did not have significantly prolonged VCA acceptance following cessation of immunosuppression compared to animals that received conditioning without BMCs, they demonstrated better early clinical outcomes and demonstrated donor-specific unresponsiveness during the presence of detectable chimerism. Conclusions: Detectable mixed chimerism following bone marrow transplantation and VCA mitigates donor-specific responses and acute rejection episodes, but does not appear to be sufficient for tolerance induction.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130654366","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}

引用次数: 10

Upper Extremity Transplantation in Non-Human Primates: An Orthotopic Model for Translational Research 非人类灵长类动物的上肢移植:一个用于转化研究的正位模型

Vascularized Composite Allotransplantation Pub Date : 2015-01-02 DOI: 10.1080/23723505.2015.1072261

D. Leonard, H. Powell, A. Albritton, K. Shanmugarajah, M. Mastroianni, Sarah Lofgren, James Winter, J. Kurtz, C. Cetrulo

{"title":"Upper Extremity Transplantation in Non-Human Primates: An Orthotopic Model for Translational Research","authors":"D. Leonard, H. Powell, A. Albritton, K. Shanmugarajah, M. Mastroianni, Sarah Lofgren, James Winter, J. Kurtz, C. Cetrulo","doi":"10.1080/23723505.2015.1072261","DOIUrl":"https://doi.org/10.1080/23723505.2015.1072261","url":null,"abstract":"Vascularized composite allotransplantation (VCA) offers unparalleled restoration of function and form following devastating musculoskeletal and soft tissue injury. However, the potential adverse effects of life-long immunosuppression remain a significant cause for concern. Therefore, while the surgical techniques necessary for VCA have developed rapidly, the immunological aspects of these procedures and the potential functional significance of immunological processes on vascularized composite allografts remain areas in which further research is required. The functional complexity of these procedures, combined with the preclinical nature of many of the research questions, necessitates the use of large animal models to most effectively address some of the outstanding hypotheses. Cynomolgus macaques are among the premier large animal models for immunological research. This manuscript describes development of an orthotopic model of upper extremity transplantation in cynomolgus macaques. Following study of the anatomy to determine feasibility, in vivo proof of concept was achieved by autologous amputation and replantation in two animals, following which a preliminary series of four allotransplants was performed. The anatomy encountered and techniques required for successful transplantation are closely comparable to those in clinical upper extremity transplantation. This is a technically challenging model, but offers a rigorous pre-clinical platform for translational research in transplant immunology, and is suitable for detailed study of the impact of immunologic processes on functional outcomes following VCA.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124055187","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}

引用次数: 4

New Clinicopathological Findings in a Patient with Face Allotransplantation 一例面部异体移植患者的临床病理新发现

Vascularized Composite Allotransplantation Pub Date : 2014-01-02 DOI: 10.4161/23723505.2014.970903

P. Petruzzo, Jean Kanitakis, S. Testelin, J. Pialat, F. Buron, O. Thaunat, L. Badet, B. Devauchelle, E. Morelon

{"title":"New Clinicopathological Findings in a Patient with Face Allotransplantation","authors":"P. Petruzzo, Jean Kanitakis, S. Testelin, J. Pialat, F. Buron, O. Thaunat, L. Badet, B. Devauchelle, E. Morelon","doi":"10.4161/23723505.2014.970903","DOIUrl":"https://doi.org/10.4161/23723505.2014.970903","url":null,"abstract":"During the follow-up the recipient developed primary asymptomatic EBV infection, followed by EBVC B-cell lymphoma and hepatic leiomyosarcoma, for which the immunosuppressive treatment was greatly reduced. During the first post-transplant year, acute rejection (AR) episodes were completely reversed with steroids. Subsequently, several episodes of AR occurred that were difficult to reverse with steroids and Campath-1; they manifested clinically with graft erythema and histologically with lichenoid changes of the epidermis and appendages. Since the second post-transplant year the allografted facial skin became progressively sclerotic and presented pigmented macules on a background of hypopigmentation and telangiectases, realizing a poikilodermatous aspect. Skin biopsies showed epidermal atrophy, basal cell vacuolization and diffuse dermal sclerosis. In the superficial dermis there were rare CD3C and CD4C lymphocytes and in the deep dermis few TIAC1 cytotoxic lymphocytes. The large vessels seemed unaffected while dermal capillaries showed thickened walls and narrowed lumina. Donor specific anti-HLA class II antibodies were detected transiently in January 2010.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124938539","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}

引用次数: 0

Costimulatory Blockade Prevents Rejection of Vascularized Composite Allografts 共刺激阻断可防止血管化复合同种异体移植物的排斥反应

Vascularized Composite Allotransplantation Pub Date : 2014-01-02 DOI: 10.4161/23723505.2014.970058

B. Oh, G. Furtmüller, Madeline L. Fryer, J. Grahammer, S. Schneeberger, G. Raimondi, Damon S. Cooney, W. Lee, G. Brandacher

引用次数: 0

Hand Transplantation in Its Fourteenth Year: The Innsbruck Experience 手部移植第14年:因斯布鲁克经验

Vascularized Composite Allotransplantation Pub Date : 2014-01-02 DOI: 10.4161/23723505.2014.973798

A. Weissenbacher, T. Hautz, G. Pierer, M. Ninković, B. Zelger, Bernhard Zelger, W. Löscher, M. Rieger, Martin Kumnig, G. Rumpold, H. Piza-Katzer, T. Bauer, R. Zimmermann, M. Gabl, R. Arora, Milomir Ninkovic, R. Margreiter, G. Brandacher, S. Schneeberger, RTI-Group Innsbruck

{"title":"Hand Transplantation in Its Fourteenth Year: The Innsbruck Experience","authors":"A. Weissenbacher, T. Hautz, G. Pierer, M. Ninković, B. Zelger, Bernhard Zelger, W. Löscher, M. Rieger, Martin Kumnig, G. Rumpold, H. Piza-Katzer, T. Bauer, R. Zimmermann, M. Gabl, R. Arora, Milomir Ninkovic, R. Margreiter, G. Brandacher, S. Schneeberger, RTI-Group Innsbruck","doi":"10.4161/23723505.2014.973798","DOIUrl":"https://doi.org/10.4161/23723505.2014.973798","url":null,"abstract":"Five patients received a bilateral hand (n = 3), a bilateral forearm (n = 1) and a unilateral hand transplant (n = 1) between 03/2000 and 03/2014. We herein describe the long-term outcome with emphasis on function, immunosuppression (IS), histomorphology and graft vascular changes. Induction therapy with antithymocyte globulin or alemtuzumab was followed by tacrolimus, prednisolone ± mycophenolate mofetil (MMF) or tacrolimus and MMF maintenance IS. Later, an mTOR-Inhibitor was added under simultaneous withdrawal or dose reduction of tacrolimus or MMF. Steroids were avoided in one and withdrawn in 2 patients. Range of motion reached up to 70% of normal with a grip strength up to 10kg. Hand function correlated with time after transplantation and amputation level and remained stable after year 5 in all cases. Intrinsic hand muscle function recovery, discriminative sensation and temperature sensation were observed after hand transplantation. Three, 7, 6, 3 and one rejection episodes were successfully treated with steroids, anti-CD25, anti-CD52 and anti-CD20 antibodies and/or intensified maintenance IS. Repetitive events of skin rejection/inflammation late after transplantation were observed in one case. Skin histology at current shows no or mild perivascular lymphocytic infiltrates without signs of progression. Vessels are patent without signs for luminal narrowing or intimal proliferation. The overall functional outcome and patient satisfaction are highly encouraging. All patients are now free of rejection with moderate levels of IS.","PeriodicalId":372758,"journal":{"name":"Vascularized Composite Allotransplantation","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114201955","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}

引用次数: 14