Rabbani Piul S, Rifkin William J, Kadle Rohini L, Rao Nakul, Diaz-Siso J Rodrigo, Abdou Salma A, Rodriguez Eduardo D, Ceradini Daniel J
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y.
Plast Reconstr Surg Glob Open. 2019 Aug 8;7(8):e2368. doi: 10.1097/GOX.0000000000002368. eCollection 2019 Aug.
Despite promising short- and long-term results to date in vascularized composite allotransplantation (VCA), acute rejection remains the most common major complication in recipients. Currently, diagnosis of acute rejection relies on clinical inspection correlated with histopathological analysis. However, disagreement exists regarding the value of full-thickness skin and mucosal biopsies and histopathology remains semiquantitative, subject to sampling bias, and prone to intra- and inter-observer variabilities. Additionally, biopsies may cause infection, scarring, and/or potentially incite rejection through immune activation after injury. Noninvasive methods to diagnose rejection represent a critical unmet need for the emerging field of VCA. Here, we propose a novel technique utilizing skin stripping of the epidermis and subsequent molecular analysis to detect known markers of acute rejection. Using a small animal VCA model, we sought to validate our epidermal sampling technique as a noninvasive diagnostic test for acute rejection.
尽管血管化复合组织异体移植（VCA）目前已取得了令人鼓舞的短期和长期效果，但急性排斥反应仍是受者中最常见的主要并发症。目前，急性排斥反应的诊断依赖于与组织病理学分析相关的临床检查。然而，对于全层皮肤和黏膜活检的价值存在分歧，并且组织病理学仍然是半定量的，容易受到抽样偏差的影响，并且观察者内部和观察者之间存在差异。此外，活检可能会导致感染、瘢痕形成，和/或在损伤后通过免疫激活潜在地引发排斥反应。诊断排斥反应的非侵入性方法是VCA这一新兴领域尚未满足的关键需求。在此，我们提出一种利用表皮剥脱及后续分子分析来检测急性排斥反应已知标志物的新技术。我们使用小动物VCA模型，试图验证我们的表皮采样技术作为急性排斥反应的非侵入性诊断测试。
