Amin Kavit R, Wong Jason K F, Fildes James E
The Manchester Collaborative Centre for Inflammation Research, University Hospital of South Manchester, Manchester, UK; The Transplant Centre, University Hospital of South Manchester, Manchester, UK; Blond McIndoe Laboratories, University of Manchester, University Hospital of South Manchester, Manchester, UK; Department of Plastic Surgery, University Hospital of South Manchester, Manchester, UK.
Blond McIndoe Laboratories, University of Manchester, University Hospital of South Manchester, Manchester, UK; Department of Plastic Surgery, University Hospital of South Manchester, Manchester, UK.
J Hand Surg Am. 2017 Dec;42(12):1019-1024. doi: 10.1016/j.jhsa.2017.09.013. Epub 2017 Oct 18.
An important and often underinvestigated contributor to solid organ transplant rejection is ischemia reperfusion injury. This pathophysiological response releases damaging reactive oxygen species and cell stress signals that initiate inflammation, which has a critical role in priming the immune system for allorecognition. In time, this renders graft dysfunction and how this response is mediated in composite tissues remains unknown. Current protocols are drawn from solid organ transplantation with little scientific basis as to how this informs current hand transplantation practices. In addition to preservation flush and allograft cooling, machine perfusion is placing itself experimentally as a concept that could act to promote viability and increase the critical ischemic window, which is especially beneficial at a time of limited donors. With the increasing prevalence worldwide of hand transplantation, we review the potential contribution of ischemia reperfusion injury to hand allograft rejection including both current and experimental strategies.
实体器官移植排斥反应的一个重要且常被忽视的因素是缺血再灌注损伤。这种病理生理反应会释放具有破坏性的活性氧和细胞应激信号，从而引发炎症，而炎症在启动免疫系统进行异体识别方面起着关键作用。随着时间的推移，这会导致移植物功能障碍，而这种反应在复合组织中是如何介导的仍不清楚。目前的方案借鉴了实体器官移植，但对于其如何指导当前的手部移植实践几乎没有科学依据。除了保存冲洗和同种异体移植物冷却外，机器灌注作为一种可促进存活并延长关键缺血时间窗的概念正在进行实验研究，这在供体有限的情况下尤其有益。随着全球手部移植的日益普及，我们综述了缺血再灌注损伤对同种异体手部移植排斥反应的潜在影响，包括当前和实验策略。
