Sarhane Karim A, Tuffaha Sami H, Broyles Justin M, Ibrahim Amir E, Khalifian Saami, Baltodano Pablo, Santiago Gabriel F, Alrakan Mohammed, Ibrahim Zuhaib
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA.
Front Immunol. 2013 Nov 25;4:406. doi: 10.3389/fimmu.2013.00406.
Advances in microsurgical techniques and immunomodulatory protocols have contributed to the expansion of vascularized composite allotransplantation (VCA) with very encouraging immunological, functional, and cosmetic results. Rejection remains however a major hurdle that portends serious threats to recipients. Rejection features in VCA have been described in a number of studies, and an international consensus on the classification of rejection was established. Unfortunately, current available diagnostic methods carry many shortcomings that, in certain cases, pose a great diagnostic challenge to physicians especially in borderline rejection cases. In this review, we revisit the features of acute skin rejection in hand and face transplantation at the clinical, cellular, and molecular levels. The multiple challenges in diagnosing rejection and in defining chronic and antibody-mediated rejection in VCA are then presented, and we finish by analyzing current research directions and novel concepts aiming at improving available diagnostic measures.
显微外科技术和免疫调节方案的进展推动了血管化复合组织异体移植（VCA）的发展，其免疫、功能和美容效果令人鼓舞。然而，排斥反应仍然是一个主要障碍，对受者构成严重威胁。许多研究已经描述了VCA中的排斥反应特征，并就排斥反应的分类达成了国际共识。不幸的是，目前可用的诊断方法存在许多缺点，在某些情况下，给医生带来了巨大的诊断挑战，尤其是在临界排斥反应病例中。在这篇综述中，我们在临床、细胞和分子水平上重新审视手部和面部移植中急性皮肤排斥反应的特征。然后介绍了VCA诊断排斥反应以及定义慢性和抗体介导的排斥反应时面临的多重挑战，最后我们分析了当前旨在改进现有诊断措施的研究方向和新概念。
