Etra Joanna W, Raimondi Giorgio, Brandacher Gerald
Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory.
Department of General Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Organ Transplant. 2018 Feb;23(1):28-33. doi: 10.1097/MOT.0000000000000490.
For patients with devastating injuries in whom standard reconstruction is not an option, vascularized composite allotransplantation (VCA) has become a viable means of restoring form and function. However, immunological rejection continues to be a problem in VCA and has not yet been fully characterized. As the field is relatively new, much of the data on rejection and immunosuppression have been extrapolated from that of solid organ transplantation. In this review, we cover the basic mechanisms of rejection as they relate specifically to VCA with analysis of recent literature and future directions.
Recent clinical studies have supported previously postulated T-cell-mediated mechanism of acute rejection and have also made strides in differentiating rejection from inflammation from other skin conditions and with different treatment regimens. Antibody-mediated rejection has been described in recent cases as well as treatment of presensitized patients receiving VCAs. With more long-term grafts, chronic changes, including vasculopathy, are being reported.
Clinically observed types of rejection in VCA include mainly cell-mediated, antibody-mediated and chronic rejection. Advances in diagnosis and treatment of rejection have been made, but there is still much to be learned about VCA-specific rejection.
对于那些遭受严重损伤且无法进行标准重建手术的患者，血管化复合组织异体移植（VCA）已成为恢复外形和功能的一种可行方法。然而，免疫排斥仍是VCA面临的一个问题，且尚未得到充分认识。由于该领域相对较新，许多关于排斥反应和免疫抑制的数据都是从实体器官移植中推断而来。在本综述中，我们结合近期文献分析和未来方向，阐述与VCA特异性相关的排斥反应基本机制。
近期临床研究支持了先前推测的急性排斥反应的T细胞介导机制，并且在区分排斥反应与其他皮肤疾病的炎症以及不同治疗方案所致炎症方面也取得了进展。近期病例报道了抗体介导的排斥反应以及对接受VCA的致敏患者的治疗情况。随着更多长期移植病例的出现，包括血管病变在内的慢性变化也有报道。
临床上观察到的VCA排斥反应类型主要包括细胞介导、抗体介导和慢性排斥。在排斥反应的诊断和治疗方面已取得进展，但对于VCA特异性排斥反应仍有许多有待了解之处。
