Sun Jiahui Angela, Adil Aisha, Biniazan Felor, Haykal Siba
Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Front Transplant. 2024 Feb 13;3:1350546. doi: 10.3389/frtra.2024.1350546. eCollection 2024.
Vascularized composite allotransplantation (VCA) is the transplantation of multiple tissues such as skin, muscle, bone, nerve, and vessels, as a functional unit (i.e., hand or face) to patients suffering from major tissue trauma and functional deficits. Though the surgical feasibility has been optimized, issues regarding graft rejection remains. VCA rejection involves a diverse population of cells but is primarily driven by both donor and recipient lymphocytes, antigen-presenting cells, macrophages, and other immune as well as donor-derived cells. In addition, it is commonly understood that different tissues within VCA, such as the skin, elicits a stronger rejection response. Currently, VCA recipients are required to follow potent and lifelong immunosuppressing regimens to maximize graft survival. This puts patients at risk for malignancies, opportunistic infections, and cancers, thereby posing a need for less perilous methods of inducing graft tolerance. This review will provide an overview of cell populations and mechanisms, specific tissue involved in VCA rejection, as well as an updated scope of current methods of tolerance induction.
血管化复合组织移植（VCA）是将皮肤、肌肉、骨骼、神经和血管等多种组织作为一个功能单元（如手或面部）移植给患有严重组织创伤和功能缺陷的患者。尽管手术可行性已得到优化，但移植物排斥问题仍然存在。VCA排斥涉及多种细胞群体，但主要由供体和受体淋巴细胞、抗原呈递细胞、巨噬细胞以及其他免疫细胞和供体来源的细胞驱动。此外，人们普遍认为VCA中的不同组织，如皮肤，会引发更强的排斥反应。目前，VCA受者需要遵循强效且终身的免疫抑制方案，以最大限度地提高移植物存活率。这使患者面临患恶性肿瘤、机会性感染和癌症的风险，因此需要采用危险性较小的诱导移植物耐受的方法。本综述将概述参与VCA排斥的细胞群体和机制、特定组织，以及当前诱导耐受方法的最新情况。
