Stead Thor S, Brydges Hilliard T, Laspro Matteo, Onuh Ogechukwu C, Chaya Bachar F, Rabbani Piul S, Lu Catherine P, Ceradini Daniel J, Gelb Bruce E, Rodriguez Eduardo D
Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America.
Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America.
Transplant Rev (Orlando). 2023 Dec;37(4):100790. doi: 10.1016/j.trre.2023.100790. Epub 2023 Aug 16.
Rejection is common and pernicious following Vascularized Composite Allotransplantation (VCA). Current monitoring and diagnostic modalities include the clinical exam which is subjective and biopsy with dermatohistopathologic Banff grading, which is subjective and invasive. We reviewed literature exploring non- and minimally invasive modalities for diagnosing and monitoring rejection (NIMMs) in VCA.
PubMed, Cochrane, and Embase databases were queried, 3125 unique articles were reviewed, yielding 26 included studies exploring 17 distinct NIMMs. Broadly, NIMMs involved Imaging, Liquid Biomarkers, Epidermal Sampling, Clinical Grading Scales, and Introduction of Additional Donor Tissue.
Serum biomarkers including MMP3 and donor-derived microparticles rose with rejection onset. Epidermal sampling non-invasively enabled measurement of cytokine & gene expression profiles implicated in rejection. Both hold promise for monitoring. Clinical grading scales were useful diagnostically as was reflection confocal microscopy. Introducing additional donor tissue showed promise for preemptively identifying rejection but requires additional allograft tissue burden for the recipient.
NIMMs have the potential to dramatically improve monitoring and diagnosis in VCA. Many modalities show promise however, additional research is needed and a multimodal algorithmic approach should be explored.
在血管化复合组织异体移植（VCA）后，排斥反应很常见且具有危害性。当前的监测和诊断方式包括主观的临床检查以及采用皮肤组织病理学班夫分级的活检，而活检既主观又具有侵入性。我们回顾了探索VCA中用于诊断和监测排斥反应的非侵入性和微创方式（NIMMs）的文献。
检索了PubMed、Cochrane和Embase数据库，共审查了3125篇独特的文章，筛选出26项纳入研究，这些研究探索了17种不同的NIMMs。大致而言，NIMMs包括成像、液体生物标志物、表皮采样、临床分级量表以及引入额外的供体组织。
包括基质金属蛋白酶3（MMP3）和供体来源的微粒在内的血清生物标志物随着排斥反应的开始而升高。表皮采样能够以非侵入性方式测量与排斥反应相关的细胞因子和基因表达谱。两者在监测方面都具有前景。临床分级量表在诊断上很有用，反射共聚焦显微镜也是如此。引入额外的供体组织在抢先识别排斥反应方面显示出前景，但需要受体承担额外的同种异体移植组织负担。
NIMMs有潜力显著改善VCA的监测和诊断。许多方式都显示出前景，然而，还需要更多的研究，并且应探索多模式算法方法。
