Huelsboemer Lioba, Boroumand Sam, Kochen Alejandro, Dony Alna, Moscarelli Jake, Hauc Sacha C, Stögner Viola A, Formica Richard N, Pomahac Bohdan, Kauke-Navarro Martin
Division of Reconstructive and Plastic Surgery, Yale School of Medicine, New Haven, CT, United States.
Regenerative Wound Healing Center, Yale School of Medicine, New Haven, CT, United States.
Front Transplant. 2024 Mar 6;3:1366243. doi: 10.3389/frtra.2024.1366243. eCollection 2024.
Recipients of Vascularized Composite Allotransplants require effective immunosuppressive therapy to prevent graft rejection. This systematic review summarizes the current body of literature on immunosuppressive regimens used in face and hand transplants while summarizing their outcome in terms of rejection, renal failure, and infections.
A systematic search of electronic databases was conducted to identify relevant studies from 1998 until July 1st, 2023. We included all studies that discussed immunosuppressive strategies in face and hand transplant recipients according to PRISMA.
The standard triple maintenance therapy was mostly adjusted due to nephrotoxicity or high incidence of rejection. The most common alternative treatments utilized were sirolimus (25/91; 27.5%) or everolimus (9/91; 9.9%) following hand- and photophoresis (7/45; 15.6%), sirolimus (5/45; 11.1%) or belatacept (1/45; 2.2%) following face transplantation. Episodes of rejection were reported in 60 (65.9%) of hand- and 33 (73%) of face transplant patients respectively. Graft loss of 12 (13.2%) hand and 4 (8.9%) face transplants was reported. Clinical CMV infection was observed in 6 (6.6%) hand and 7 (15.5%) face transplant recipients.
Based on the herein presented data, facial grafts exhibited a heightened incidence of rejection episodes and CMV infections. Facial mucosa adds complexity to the immunological graft composition highlighting the need of individualized immunosuppressive regimens and further research.
血管化复合组织异体移植受者需要有效的免疫抑制治疗以防止移植物排斥反应。本系统评价总结了目前关于面部和手部移植中使用的免疫抑制方案的文献，并总结了它们在排斥反应、肾衰竭和感染方面的结果。
对电子数据库进行系统检索，以识别1998年至2023年7月1日期间的相关研究。根据PRISMA，我们纳入了所有讨论面部和手部移植受者免疫抑制策略的研究。
标准的三联维持治疗大多因肾毒性或排斥反应发生率高而进行调整。最常用的替代治疗方法是手部移植后使用西罗莫司（25/91；27.5%）或依维莫司（9/91；9.9%）以及光化学疗法（7/45；15.6%），面部移植后使用西罗莫司（5/45；11.1%）或贝拉西普（1/45；2.2%）。手部移植患者中有60例（65.9%）、面部移植患者中有33例（73%）报告了排斥反应发作。报告了12例（13.2%）手部移植和4例（8.9%）面部移植的移植物丢失。6例（6.6%）手部移植受者和7例（15.5%）面部移植受者观察到临床巨细胞病毒感染。
基于本文提供的数据，面部移植物排斥反应发作和巨细胞病毒感染的发生率较高。面部黏膜增加了免疫移植物组成的复杂性，突出了个体化免疫抑制方案的必要性和进一步研究的需求。
