Baltimore, Md. From The Johns Hopkins University School of Medicine and R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.
Plast Reconstr Surg. 2010 Feb;125(2):538-546. doi: 10.1097/PRS.0b013e3181c722a8.
Since 2005, seven facial composite tissue allotransplantations have been performed in five different centers in three countries. Four teams have reported their outcomes in separate publications. The authors sought to review the first four global experiences and compare several factors. This review facilitates discussion of indications and future implications for facial composite tissue allotransplantation.
A thorough review of five publications by the four transplantation groups was conducted. Additional information gathered from official press releases or surgeon presentations was also included. Summary of data and comparative analysis were performed.
Patient selection is of utmost importance; specifically, patient compliance with the immunosuppressive and postoperative regimen. Functional and aesthetic improvement must be achieved by composite tissue allotransplantation reconstruction to justify lifelong immunosuppression; therefore, patients with loss of perioral and/or periorbital structures have priority. Objective measures are required to monitor this functional restoration. The importance of viral mismatch was demonstrated by the severe cytomegalovirus viremia observed in the third facial transplant patient. Finally, the mucosa appears to be a predictor of rejection and is more antigenic than skin. Histopathologic diagnosis of mucosal rejection may allow early treatment and prevention of subsequent diffuse composite tissue allotransplant rejection.
The pioneering teams that ventured into facial composite tissue allotransplantation offered their patients improved aesthetic, functional, and social outcomes not possible with conventional measures in a single procedure. In addition, these innovative facial composite tissue allografts have provided early data on important factors related to patient selection, donor/recipient matching, immunosuppressive protocols, objective measures of functional recovery, and monitoring of acute graft rejection.
自 2005 年以来，在三个国家的五个不同中心已经进行了七例面部复合组织同种异体移植。四个团队分别在不同的出版物中报告了他们的结果。作者旨在回顾前四个全球经验，并比较几个因素。该综述有助于讨论面部复合组织同种异体移植的适应证和未来意义。
对四个移植组的五篇文献进行了全面回顾。还包括从官方新闻稿或外科医生报告中收集的其他信息。对数据进行总结和比较分析。
患者的选择至关重要；特别是，患者对免疫抑制和术后方案的依从性。为了证明终生免疫抑制的合理性，复合组织同种异体移植重建必须实现功能和美学改善；因此，有口周和/或眶周结构丧失的患者具有优先权。需要客观的措施来监测这种功能恢复。第三位面部移植患者出现严重巨细胞病毒血症，表明病毒错配的重要性。最后，粘膜似乎是排斥反应的预测因子，比皮肤更具有抗原性。粘膜排斥的组织病理学诊断可能允许早期治疗和预防随后的弥漫性复合组织同种异体移植排斥反应。
敢于尝试面部复合组织同种异体移植的先驱团队为他们的患者提供了改善的美学、功能和社会结果，这在单一手术中是不可能实现的。此外，这些创新的面部复合组织同种异体移植物提供了与患者选择、供体/受者匹配、免疫抑制方案、功能恢复的客观测量以及急性移植物排斥监测相关的重要因素的早期数据。
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