Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation

The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread ap...

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Autores principales:	Jerry Huanda Yang, Ariel C. Johnson, Salih Colakoglu, Christene A. Huang, David Woodbridge Mathes
Formato:	article
Lenguaje:	EN
Publicado:	Korean Society of Plastic and Reconstructive Surgeons 2021
Materias:	vascularized composite allografts transplantation immunosuppression face transplantation hand transplantation Surgery RD1-811
Acceso en línea:	https://doaj.org/article/f9971549a92240978da89d7d9c4ced46
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spelling	oai:doaj.org-article:f9971549a92240978da89d7d9c4ced462021-11-25T06:04:37ZClinical and preclinical tolerance protocols for vascularized composite allograft transplantation2234-61632234-617110.5999/aps.2021.00927https://doaj.org/article/f9971549a92240978da89d7d9c4ced462021-11-01T00:00:00Zhttp://www.e-aps.org/upload/pdf/aps-2021-00927.pdfhttps://doaj.org/toc/2234-6163https://doaj.org/toc/2234-6171The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread application of VCAs is the side effect profile associated with the current immunosuppressive regimen, which can cause a wide array of complications such as infection, malignancy, and even death. Significant concerns remain regarding whether the treatment outweighs the risk. The potential solution to this dilemma would be achieving VCA tolerance, which would allow recipients to receive allografts without significant immunosuppression and its sequelae. Promising tolerance protocols are being studied in kidney transplantation; four major trials have attempted to withdraw immunosuppressive treatment with various successes. The common theme in all four trials is the use of radiation treatment and donor cell transplantation. The knowledge gained from these trials can provide valuable insight into the development of a VCA tolerance protocol. Despite similarities, VCAs present additional barriers compared to kidney allografts regarding tolerance induction. VCA donors are likely to be deceased, which limits the time for significant pre-conditioning. VCA donors are also more likely to be human leukocyte antigen–mismatched, which means that tolerance must be induced across major immunological barriers. This review also explores adjunct therapies studied in large animal models that could be the missing element in establishing a safe and stable tolerance induction method.Jerry Huanda YangAriel C. JohnsonSalih ColakogluChristene A. HuangDavid Woodbridge MathesKorean Society of Plastic and Reconstructive Surgeonsarticlevascularized composite allograftstransplantationimmunosuppressionface transplantationhand transplantationSurgeryRD1-811ENArchives of Plastic Surgery, Vol 48, Iss 6, Pp 703-713 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	vascularized composite allografts transplantation immunosuppression face transplantation hand transplantation Surgery RD1-811
spellingShingle	vascularized composite allografts transplantation immunosuppression face transplantation hand transplantation Surgery RD1-811 Jerry Huanda Yang Ariel C. Johnson Salih Colakoglu Christene A. Huang David Woodbridge Mathes Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
description	The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread application of VCAs is the side effect profile associated with the current immunosuppressive regimen, which can cause a wide array of complications such as infection, malignancy, and even death. Significant concerns remain regarding whether the treatment outweighs the risk. The potential solution to this dilemma would be achieving VCA tolerance, which would allow recipients to receive allografts without significant immunosuppression and its sequelae. Promising tolerance protocols are being studied in kidney transplantation; four major trials have attempted to withdraw immunosuppressive treatment with various successes. The common theme in all four trials is the use of radiation treatment and donor cell transplantation. The knowledge gained from these trials can provide valuable insight into the development of a VCA tolerance protocol. Despite similarities, VCAs present additional barriers compared to kidney allografts regarding tolerance induction. VCA donors are likely to be deceased, which limits the time for significant pre-conditioning. VCA donors are also more likely to be human leukocyte antigen–mismatched, which means that tolerance must be induced across major immunological barriers. This review also explores adjunct therapies studied in large animal models that could be the missing element in establishing a safe and stable tolerance induction method.
format	article
author	Jerry Huanda Yang Ariel C. Johnson Salih Colakoglu Christene A. Huang David Woodbridge Mathes
author_facet	Jerry Huanda Yang Ariel C. Johnson Salih Colakoglu Christene A. Huang David Woodbridge Mathes
author_sort	Jerry Huanda Yang
title	Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
title_short	Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
title_full	Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
title_fullStr	Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
title_full_unstemmed	Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
title_sort	clinical and preclinical tolerance protocols for vascularized composite allograft transplantation
publisher	Korean Society of Plastic and Reconstructive Surgeons
publishDate	2021
url	https://doaj.org/article/f9971549a92240978da89d7d9c4ced46
work_keys_str_mv	AT jerryhuandayang clinicalandpreclinicaltoleranceprotocolsforvascularizedcompositeallografttransplantation AT arielcjohnson clinicalandpreclinicaltoleranceprotocolsforvascularizedcompositeallografttransplantation AT salihcolakoglu clinicalandpreclinicaltoleranceprotocolsforvascularizedcompositeallografttransplantation AT christeneahuang clinicalandpreclinicaltoleranceprotocolsforvascularizedcompositeallografttransplantation AT davidwoodbridgemathes clinicalandpreclinicaltoleranceprotocolsforvascularizedcompositeallografttransplantation
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Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation

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