Immunological Challenges in Vascularised Composite Allotransplantation

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• 作者：Emmanuel Morelon ; Jean Kanitakis ; Palmina Petruzzo…
• 关键词：Composite tissue allotransplantation ; Vascularised composite tissue allotransplantation ; Hand and face allotransplantation ; Acute rejection ; Chronic rejection ; Cellular and humoral immune response ; Immunosuppression
• 刊名：Current Transplantation Reports
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：2
• 期：3
• 页码：276-283
• 全文大小：666KB
• 参考文献：Papers of particular interest, published recently, have been highlighted as: 鈥?Of importance 鈥⑩€?Of major importance1.Petruzzo P, Lanzetta M, Dubernard JM, et al. The international registry on hand and composite tissue transplantation. Transplantation. 2010;90(12):1590鈥?.PubMed CrossRef
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  9.Siemionow M, Papay F, Alam D, et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet. 2009;374:203.PubMed CrossRef
  10.Pomahac B, Pribaz J, Eriksson E, et al. Three patients with full facial transplantation. N Engl J Med. 2012;366(8):715鈥?2.PubMed CrossRef
  11.Jensen SE, Butt Z, Bill A, et al. Quality of life consideration in upper limb transplantation: review and future directions. J Hand Surg [Am]. 2012;37(10):2126鈥?5.CrossRef
  12.Loupy A, Hill GS, Jordan SC. The impact of donor-specific anti-HLA antibodies on late kidney allograft failure. Nat Rev Nephrol. 2012;8(6):348鈥?7.PubMed CrossRef
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  15.Schneeberger S, Landin L, Jableki J, ESOT CTA Working Group, et al. Achievements and challenges in composite tissue allotransplantation. Transpl Int. 2011;24(8):760鈥?.PubMed CrossRef
  16.Murray JE. Organ transplantation (skin, kidney, heart) and the plastic surgeon. Plast Reconstr Surg. 1971;47(5):425鈥?1.PubMed CrossRef
  17.Lee WP, Yaremchuk MJ, Pan YC, Randolph MA, Tan CM, Weiland AJ. Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr Surg. 1991;87(3):401鈥?1.PubMed CrossRef
  18.Thaunat O, Badet L, El-Jaafari A, Kanitakis J, Dubernard JM, Morelon E. Composite tissue allograft extends a helping hand to transplant immunologists. Am J Transplant. 2006;6(10):2238鈥?2.PubMed CrossRef
  19.Kanitakis J, Jullien D, Petruzzo P, et al. Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation. 2003;76(4):688鈥?3.PubMed CrossRef
  20.Kanitakis J, Petruzzo P, Jullien D, et al. Pathological score for the evaluation of allograft rejection in human hand (composite tissue) allotransplantation. Eur J Dermatol. 2005;15(4):235鈥?.PubMed
  21.Kanitakis J. The challenge of dermatopathological diagnosis of composite tissue allograft rejection: a review. J Cutan Pathol. 2008;35(8):738鈥?4.PubMed CrossRef
  22.Hautz T, Zelger B, Grahammer J, et al. Molecular markers and targeted therapy of skin rejection in composite tissue allotransplantation. Am J Transplant. 2010;10(5):1200鈥?.PubMed CrossRef
  23.Hautz T, Zelger BG, Weissenbacher A, et al. Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation. Clin Transplant. 2013;27(2):E81鈥?0.PubMed CrossRef
  24.Cendales L, Kanitakis J, Schneeberger S, et al. The Banff 2007 working classification of skin-containing composite tissue allograft pathology. Am J Transplant. 2008;8(7):1396鈥?00.PubMed CrossRef
  25.Kanitakis J, Badet L, Petruzzo P, et al. Clinicopathologic monitoring of the skin and oral mucosa of the first human face allograft: report on the first eight months. Transplantation. 2006;82(12):1610鈥?.PubMed CrossRef
  26.鈥⑩€?/div>Petruzzo P, Kanitakis J, Badet L, et al. Long-term follow-up in composite tissue allotransplantation: in-depth study of five (hand and face) recipients. Am J Transplant. 2011;11(4):808鈥?6. This retrospective analysis suggests that the incidence of chronic rejection is low in hand and face recipients compliant with triple immunosuppressive therapy.PubMed CrossRef
  27.Conrad A, Brunet AS, Hervieu V, et al. Epstein-Barr virus-associated smooth muscle tumors in a composite tissue allograft and a pediatric liver transplant recipient. Transpl Infect Dis. 2013;15(5):E182鈥?.PubMed
  28.Petruzzo P, Kanitakis J, Testelin S, et al. Clinical and histological findings of chronic rejection in a patient with face allotransplantation. Transplantation. 2015 [In press].
  29.Kanitakis J, McGregor B, Badet L, et al. Absence of C4d deposition in human composite tissue (hands and face) allograft biopsies: an immunoperoxidase study. Transplantation. 2007;84(2):265鈥?.PubMed CrossRef
  30.Landin L, Cavadas PC, Iba帽ez J, Roger I, Vera-Sempere F. CD3+-mediated rejection and C4d deposition in two composite tissue (bilateral hand) allograft recipients after induction with alemtuzumab. Transplantation. 2009;87(5):776鈥?1.PubMed CrossRef
  31.鈥?/div>Chandraker A, Arscott R, Murphy GF, et al. The management of antibody-mediated rejection in the first presensitized recipient of a full-face allotransplant. Am J Transplant. 2014;14(6):1446鈥?2. This is the first reported case of acute humoral rejection in face transplant patient who received face transplantation despite preformed DSA.PubMed CrossRef
  32.Weissenbacher A, Hautz T, Zelger B, et al. Antibody-mediated rejection in hand transplantation. Transplant Int. 2014;27(2):e13鈥?.CrossRef
  33.Wu S, Xu H, Chen B, et al. Sensitized recipients exhibit accelerated but not hyperacute rejection of vascularized composite tissue allografts. Transplantation. 2011;92(6):627鈥?3.PubMed Central PubMed CrossRef
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  35.鈥⑩€?/div>Kaufman CL, Ouseph R, Blair B, et al. Graft vasculopathy in clinical hand transplantation. Am J Transplant. 2012;12(4):1004鈥?6. This paper reports for the first time transplant vasculopathy in the VCA setting.PubMed CrossRef
  36.Kanitakis J, Karayannopoulou G, Lanzetta M, Petruzzo P. Graft vasculopathy in the skin of a human hand allograft: implications for diagnosis of rejection of vascularized composite allografts. Transplant Int. 2014;27(11):e118鈥?3.CrossRef
  37.Bachelet T, Couzi L, Lepreux S, Legeret M,,Pariscoat G, Guidicelli G, Anies G, Merville P, Taupin JL. Kidney intragraft DSA detection implements the definition of antibody-mediated lesions and is associated with a poor prognosis of the graft. Am J Transplant. 2013.
  38.Siemionow MZ, Izycki DM, Zielinski M. Donor-specific tolerance in fully major histocompatibility major histocompatibility complex-mismatched limb allograft transplants under an anti-alphabeta T-cell receptor monoclonal antibody and cyclosporine A protocol. Transplantation. 2003;76(12):1662鈥?.PubMed CrossRef
  39.Siemionow M, Izycki D, Ozer K, Ozmen S, Klimczak A. Role of thymus in operational tolerance induction in limb allograft transplant model. Transplantation. 2006;81(11):1568鈥?6.PubMed CrossRef
  40.Siemionow M, Klimczak A, Unal S, Agaoglu G, Carnevale K. Hematopoietic stem cell engraftment and seeding permits multi-lymphoid chimerism in vascularized bone marrow transplants. Am J Transplant. 2008;8(6):1163鈥?6.PubMed CrossRef
  41.Rahhal DN, Xu H, Huang WC, et al. Dissociation between peripheral blood chimerism and tolerance to hindlimb composite tissue transplants: preferential localization of chimerism in donor bone. Transplantation. 2009;88(6):773鈥?1.PubMed Central PubMed CrossRef
  42.Huang WC, Lin JY, Wallace CG, Chuang WY, Wei FC, Liao SK. Vascularized bone grafts within composite tissue allotransplants can autocreate tolerance through mixed chimerism with partial myeloablative conditioning: an experimental study in rats. Plast Reconstr Surg. 2010;125(4):1095鈥?03.PubMed
  43.Schneeberger S, Gorantla VS, Brandacher G, et al. Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression. Ann Surg. 2013;257(2):345鈥?1.PubMed Central PubMed CrossRef
  
• 作者单位：Emmanuel Morelon (1) (2) (3)
  Jean Kanitakis (4)
  Palmina Petruzzo (5) (6)
  Lionel Badet (3) (5)
  Olivier Thaunat (1) (2) (3)
  
  1. Department of Transplantation, Nephrology and Clinical Immunology, H么pital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
  2. Universit茅 de Lyon, Lyon, France
  3. INSERM U 1111, Lyon, France
  4. Dermatology Department, H么pital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
  5. Department of Urology and Transplantation, H么pital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
  6. Department of Surgery, University of Cagliari, Cagliari, Italy
  
• 刊物类别：Transplant Surgery; Immunology; Surgery;
• 刊物主题：Transplant Surgery; Immunology; Surgery;
• 出版者：Springer International Publishing
• ISSN：2196-3029

文摘

Vascularised composite allotransplantation (VCA) is a new field in transplantation aiming to improve disabled patients鈥?quality of life. Two tissues appear to play an important role in the immune response: the skin, which is highly immunogenic and the main target of T-lymphocyte-mediated acute rejection, and the vessels, which are targeted by the humoral arm of recipient鈥檚 immune response, which lead to chronic rejection, as in solid organ transplantation. In preclinical models, transplantation of bone marrow is associated with mixed chimerism inducing and maintaining tolerance to allogeneic VCA. However, this is not the case clinically. Immunosuppression used in VCA patients is similar to that in solid organ transplantation with similar side effects and complications. However, as a life-enhancing transplant, the careful selection of recipients and a close follow-up cannot be overemphasised. Keywords Composite tissue allotransplantation Vascularised composite tissue allotransplantation Hand and face allotransplantation Acute rejection Chronic rejection Cellular and humoral immune response Immunosuppression