Caterson Edward J, Lopez Joseph, Medina Miguel, Pomahac Bohdan, Tullius Stefan G
Divisions of Plastic Surgery and Transplant Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Craniofac Surg. 2013 Jan;24(1):51-6. doi: 10.1097/SCS.0b013e31827104e1.
Vascularized composite allotransplantation may now be considered a viable treatment option in patients with complex craniofacial and limb defects. However, the field is still in its infancy, and challenges continue to exist. These challenges, most notably the adverse effects of lifelong immunosuppression, must be weighed against the benefits of the procedure. Improvements in this risk-benefit ratio can be achieved by achieving tolerance and preventing rejection. Five decades after Dr. Joseph E. Murray introduced the field of transplantation to the world, we now have a better understanding of the immunologic factors that may contribute to rejection and inhibit tolerance. In this article, we review emerging evidence that suggests that "danger signals" associated with ischemia-reperfusion injury contribute to innate immune activation, promoting rejection, and inhibiting tolerance. Based on this understanding, we also describe several strategies that may ameliorate the damaging effects of ischemia-reperfusion and the clinical implications of ischemia-reperfusion on the vascularized composite tissue allotransplantation outcome.
对于患有复杂颅面和肢体缺损的患者，血管化复合组织异体移植现在可被视为一种可行的治疗选择。然而，该领域仍处于起步阶段，挑战依然存在。这些挑战，最显著的是终身免疫抑制的不良反应，必须与该手术的益处相权衡。通过实现免疫耐受和预防排斥反应，可以提高这种风险效益比。在约瑟夫·E·默里博士将移植领域介绍给世界五十年后，我们现在对可能导致排斥反应和抑制免疫耐受的免疫因素有了更好的理解。在本文中，我们回顾了新出现的证据，这些证据表明与缺血再灌注损伤相关的“危险信号”会导致先天性免疫激活，促进排斥反应并抑制免疫耐受。基于这一认识，我们还描述了几种可能减轻缺血再灌注损伤影响的策略，以及缺血再灌注对血管化复合组织异体移植结果的临床意义。
