Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202, United States.
Transplantation Biology, Departments of Surgery and of Microbiology & Immunology, University of Michigan, Ann Arbor, MI 48109, United States.
Hum Immunol. 2019 Jun;80(6):385-392. doi: 10.1016/j.humimm.2019.03.002. Epub 2019 Mar 2.
Vascularized composite allotransplantation (VCA) has emerged as the most recent field of transplantation to offer an alternative treatment for those patients that have failed or are not suitable candidates for conventional therapy. Most of the current clinical experience in this field is with recipients of skin containing grafts such as the face, upper extremity and abdominal wall transplants. Like solid organ recipients, VCA recipients require lifelong systematic immunosuppression to maintain their grafts. To date, the most successful immunosuppressant regimens are calcineurin inhibitor based and have been targeted to the control of T cells. While these regimens have resulted in excellent short term graft survival in solid organ transplantation, achieving significant improvements in long term survival has been more challenging. The reasons are multi-factorial, but a role for B cells and humoral immunity has been proposed. Antibody mediated rejection leading to chronic rejection has been cited as the leading cause of renal graft loss. While the number of VCA transplants performed is still small, evidence to date suggests that antibody mediated rejection may occur less frequently than seen in solid organ transplants. Here we will discuss the role of B cell immunity in solid organ transplantation as it pertains and contrasts to the field of VCA and present some examples of possible sequela of B cell immunity in a series of hand transplant recipients.
血管化复合组织同种异体移植（VCA）作为移植领域的最新进展，为那些常规治疗失败或不适用的患者提供了一种替代治疗方法。目前，该领域的大部分临床经验是针对接受皮肤包含移植物的患者，如面部、上肢和腹壁移植。与实体器官受者一样，VCA 受者需要终生接受系统性免疫抑制治疗以维持移植物。迄今为止，最成功的免疫抑制剂方案是基于钙调磷酸酶抑制剂的方案，并针对 T 细胞的控制。虽然这些方案在实体器官移植中导致了极好的短期移植物存活率，但在长期存活率方面取得显著改善更具挑战性。原因是多方面的，但已提出 B 细胞和体液免疫的作用。抗体介导的排斥反应导致慢性排斥反应已被认为是导致肾移植失败的主要原因。虽然 VCA 移植的数量仍然较少，但目前的证据表明，抗体介导的排斥反应发生的频率可能低于实体器官移植。在这里，我们将讨论 B 细胞免疫在实体器官移植中的作用，以及它与 VCA 领域的关系，并介绍一系列手移植受者中 B 细胞免疫可能产生的一些后果的实例。
