Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
J Plast Reconstr Aesthet Surg. 2021 Feb;74(2):327-335. doi: 10.1016/j.bjps.2020.10.003. Epub 2020 Oct 21.
Local immunosuppression in vascularized composite allotransplantation (VCA) aims to minimize immunosuppressant-related toxic and malignant side effects. Promising allograft survival data have been published by multiple workgroups. In this systematic review, we examine preclinical animal studies that investigated local immunosuppression in VCA.
We conducted a systematic review of manuscripts listed in the MEDLINE and PubMed database concerning preclinical VCA models. Papers included had to be available as full-text and written in English. Non-VCA studies, human trials, and studies using cell-based therapy strategies were excluded. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Literature research retrieved 980 articles. Ten studies published between 2010 and 2019 met the inclusion and exclusion criteria. Seven out of ten articles demonstrated a significant prolongation of allograft survival by using local immunosuppression. Five articles employed tacrolimus (TAC) as the main immunosuppressive agent. Seven studies performed hind-limb VCA in a rat model.
The easily accessible location of skin containing VCAs makes it an ideal candidate for local immunosuppression. Published preclinical data are very promising in terms of improved allograft survival and reduced systemic toxicity.
血管化复合组织移植（VCA）中的局部免疫抑制旨在最大限度地减少免疫抑制剂相关的毒性和恶性副作用。多个工作组已经发表了有希望的移植物存活数据。在本系统评价中，我们研究了评估 VCA 中局部免疫抑制的临床前动物研究。
我们对 MEDLINE 和 PubMed 数据库中有关临床前 VCA 模型的文献进行了系统评价。必须能够提供全文并以英文书写。排除非 VCA 研究、人体试验和使用基于细胞的治疗策略的研究。我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
文献研究检索到 980 篇文章。2010 年至 2019 年期间发表的 10 项研究符合纳入和排除标准。十分之七的文章通过使用局部免疫抑制显著延长了移植物的存活时间。五篇文章使用他克莫司（TAC）作为主要免疫抑制剂。七项研究在大鼠模型中进行了后肢 VCA。
皮肤包含 VCA 的位置容易接近，使其成为局部免疫抑制的理想候选物。已发表的临床前数据在改善移植物存活率和降低全身毒性方面非常有前景。
