Howsare Molly, Jones Christopher M, Ramirez Allan M
aDepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine bDepartment of Surgery, Division of Hepatobiliary Surgery and Transplantation, University of Louisville cTrager Transplant Center, Jewish Hospital, Louisville, Kentucky, USA.
Curr Opin Organ Transplant. 2017 Oct;22(5):463-469. doi: 10.1097/MOT.0000000000000456.
Over the last two decades advances in vascularized composite allotransplantation have achieved clinically significant milestones. This review provides a synopsis for immunosuppressive maintenance therapy for VCA and discusses the nuances surrounding the determination of the right amount of immunosuppression in vascularized composite allotransplantation.
Functional results after vascularized composite allotransplantation remain highly encouraging as are the immunologic outcomes, however, challenges persist. Currently, although conventional immunosuppressive protocols have been successful at preventing allograft loss; they have not totally prevented episodes of acute rejection in the skin. Furthermore, vascularized composite allotransplantation carries a significant risk profile attributed to the complications of life-long, high-dose immunosuppression regimens.
Examining conventional treatment protocols can lead to the development of novel immunosuppression concepts that will ultimately assist in favorably tilting the risk-benefit scale for these life-changing transplants.
在过去二十年中，血管化复合组织异体移植取得了具有临床意义的重大进展。本综述概述了血管化复合组织异体移植的免疫抑制维持治疗，并讨论了在血管化复合组织异体移植中确定合适免疫抑制剂量的细微差别。
血管化复合组织异体移植后的功能结果和免疫结果仍然非常令人鼓舞，然而，挑战依然存在。目前，尽管传统免疫抑制方案已成功预防了移植物丢失，但它们尚未完全预防皮肤急性排斥反应的发生。此外，由于终身高剂量免疫抑制方案的并发症，血管化复合组织异体移植具有显著的风险。
审视传统治疗方案可促使新的免疫抑制概念的发展，这最终将有助于为这些改变生活的移植手术更有利地平衡风险效益比。
