Huelsboemer Lioba, Moscarelli Jake, Dony Alna, Boroumand Sam, Kochen Alejandro, Knoedler Leonard, Yu Catherine T, Hauc Sacha C, Stögner Viola A, Formica Richard N, Lian Christiane G, Murphy Georg F, Pomahac Bohdan, Kauke-Navarro Martin
Division of Reconstructive and Plastic Surgery, Yale School of Medicine, New Haven, CT, United States.
School of Medicine, University of Leeds, Woodhouse, Leeds, United Kingdom.
Front Transplant. 2024 Sep 3;3:1442006. doi: 10.3389/frtra.2024.1442006. eCollection 2024.
To date, little is known about the mechanisms of rejection in vascularized composite allotransplantation, particularly for antibody mediated rejection. Additionally, no clear guidelines exist for the diagnosis and management of antibody-mediated rejection in vascularized composite allotransplantation. A systematic review of electronic databases (Embase and PubMed) was conducted to evaluate the relationship of donor specific antibodies and C4d deposition in correlation with cellular rejection following hand and face transplantation reported by centers between 1998 and July 2023. We extracted data on serum donor specific antibodies at the time of biopsy proven rejection according to Banff classification and C4d staining of target tissues. Mann-Whitney U tests were performed to compare rejection grade between groups divided by status of C4d deposition and serum donor specific antibodies, and Fisher's Exact test was used to assess association between the two markers. This review adhered to PRISMA guidelines. A total of 26 patients (5 face, 21 hand) were identified and data on 90 acute rejection episodes with information on Banff grade, donor specific antibody status, and C4d deposition were available. Donor specific antibodies were found to be associated with higher rejection grade (= 0.005). C4d was not found to be associated with higher rejection grade (= 0.33). Finally, no significant association was found between concurrent status of the two markers (= 0.23). These findings suggest that the presence of donor specifc antibodies may be associated with higher grades of acute cellular rejection following hand and face transplantation. More consistent reporting on rejection episodes is needed in order to better understand antibody-mediated rejection in vascularized composite allotransplantation.
迄今为止，关于血管化复合组织移植排斥反应的机制，尤其是抗体介导的排斥反应，人们了解甚少。此外，对于血管化复合组织移植中抗体介导排斥反应的诊断和管理，尚无明确的指南。我们对电子数据库（Embase和PubMed）进行了系统综述，以评估1998年至2023年7月期间各中心报告的手和面部移植后供体特异性抗体与C4d沉积与细胞排斥反应之间的关系。我们根据Banff分类法提取了活检证实排斥反应时血清供体特异性抗体的数据，以及靶组织的C4d染色数据。采用Mann-Whitney U检验比较按C4d沉积状态和血清供体特异性抗体分组的各亚组之间的排斥反应分级，并使用Fisher精确检验评估这两个标志物之间的关联。本综述遵循PRISMA指南。共纳入26例患者（5例面部移植，21例手部移植），并获得了90次急性排斥反应发作的数据，包括Banff分级、供体特异性抗体状态和C4d沉积情况。发现供体特异性抗体与较高的排斥反应分级相关（=0.005）。未发现C4d与较高的排斥反应分级相关（=0.33）。最后，未发现这两个标志物的同时存在状态之间存在显著关联（=0.23）。这些发现表明，供体特异性抗体的存在可能与手和面部移植后较高等级的急性细胞排斥反应相关。为了更好地理解血管化复合组织移植中的抗体介导排斥反应，需要更一致地报告排斥反应发作情况。
