The Experts below are selected from a list of 1344 Experts worldwide ranked by ideXlab platform
Vijay S. Gorantla - One of the best experts on this subject based on the ideXlab platform.
-
Is Skin the Most Allogenic Tissue in Vascularized Composite Allotransplantation and a Valid Monitor of the Deeper Tissues
Plastic and reconstructive surgery, 2019Co-Authors: Nicholas L. Robbins, Vijay S. Gorantla, Matthew J. Wordsworth, Bijaya K. Parida, Bruce Kaplan, Erik K Weitzel, Warren C. BreidenbachAbstract:Since the 1960s, skin has been considered to be the most allogenic tissue in humans. This tenet has remained unquestioned in the reconstructive transplant arena, which has led to skin serving as the sole monitor for early rejection in Vascularized Composite Allotransplantation. In this article, the authors question the validity of this belief. The authors' hypothesis is that skin is not always an accurate monitor of rejection in the deep tissues, thus questioning the positive and negative predictive value of the punch biopsy for suspected Vascularized Composite Allotransplantation rejection. A search was carried out identifying Vascularized Composite Allotransplantation publications where the allogenicity of transplanted skin was evaluated. Eighteen publications claimed skin was found to be the most allogenic tissue in humans, justifying its use as a superior monitor for rejection. Eight publications demonstrated skin to be a poor monitor of rejection deeper to the skin. Two Vascularized Composite Allotransplantation animal studies reported skin rejecting simultaneously with the deeper tissues. Finally, three publications discussed a skin and kidney allograft, transplanted simultaneously, indicating skin allogenicity was equivalent to the that of the kidney allograft. Much of the literature in human Vascularized Composite Allotransplantation claims skin to be an excellent monitor of the deep tissues. The conclusion from this study is that skin does not always function as a good monitor for what could be rejecting in the deep tissues. The authors believe continued research is necessary to focus on expanding novel monitoring techniques and technologies to accurately diagnose Vascularized Composite Allotransplantation rejection without tissue destruction.
-
Novel Nanoimaging Strategies for Noninvasive Graft Monitoring in Vascularized Composite Allotransplantation
Current Transplantation Reports, 2018Co-Authors: Jelena M. Janjic, Vijay S. GorantlaAbstract:This article focuses on the unmet needs and key challenges in Vascularized Composite Allotransplantation (VCA) and the opportunities for current nanotechnology advances in therapeutics and diagnostics for personalized treatment and optimization of clinical outcomes. The transformative role of nanoimaging as a noninvasive tool in the longitudinal surveillance of acute and chronic rejection after VCA is critically reviewed. Nanoimaging can inform management decisions and guide continuous treatment adjustments over time in patients to improve safety and efficacy in VCA. Nanoimaging signatures can be unbiased and quantitative measures of treatment effectiveness as well as medication adherence, both of which are critical prerequisites for overall graft survival and patient quality of life.
-
the influence of timing and frequency of adipose derived mesenchymal stem cell therapy on immunomodulation outcomes after Vascularized Composite Allotransplantation
Transplantation, 2017Co-Authors: Jan A Plock, Mario G. Solari, Jonas T Schnider, Riccardo Schweizer, Wensheng Zhang, Wakako Tsuji, Matthias Waldner, Kacey G Marra, Peter J Rubin, Vijay S. GorantlaAbstract:BackgroundCellular therapies for immunomodulation in Vascularized Composite Allotransplantation (VCA) have gained importance due to their potential for minimization of immunosuppression. Adipose-derived (AD) mesenchymal stem cells (MSCs) especially have shown encouraging potential. We investigated t
-
Single Implantable FK506 Disk Prevents Rejection in Vascularized Composite Allotransplantation.
Plastic and reconstructive surgery, 2017Co-Authors: Jignesh V. Unadkat, Vijay S. Gorantla, Mario G. Solari, Jonas T Schnider, Wakako Tsuji, Kacey G Marra, Firuz G. Feturi, Jacqueline M. Bliley, Raman Venkataramanan, Alexander M. SpiessAbstract:BACKGROUND In Vascularized Composite Allotransplantation, medication nonadherence leads to increased acute rejections. Improving medication adherence would improve overall allograft survival. Regionally delivered immunosuppression, targeted to sites of allorecognition, may reduce or eliminate the need for daily systemic immunosuppression. METHODS The authors developed biodegradable FK disks containing FK506-loaded double-walled microspheres and tested their efficacy at preventing rejection in a Brown-Norway-to-Lewis rat hindlimb transplantation model. In some experimental group animals, one FK disk was implanted subcutaneously either in native nontransplanted leg or in a transplanted allograft. Regular blood FK506 levels were measured. The endpoint was 180-day allograft survival or grade 3 rejection. At the endpoint, tissue FK506 levels were measured and mixed lymphocytic reaction was performed. RESULTS A single FK disk maintained systemic blood FK506 levels between 5 and 15 ng/ml for 146 ± 11.1 days. After that, the levels declined to less than 5 ng/ml through the endpoint. There was significantly increased FK506 concentration in groin lymph nodes draining the implanted FK disk. Compared with other groups, animals with an FK disk in the transplanted allograft had 100 percent allograft survival to more than 180 days despite subtherapeutic levels below 5 ng/ml. In these animals, significant T-cell hyporesponsiveness was seen in groin lymph nodes draining the FK disk compared with robust splenic T-cell proliferation. CONCLUSIONS Sustained regional immunosuppression (with a single FK506 disk) maintained the allograft by means of a high regional concentration of FK506. Notably, this was achieved at subtherapeutic blood concentrations of FK506, without any further systemic FK506 administration.
-
Development of a Clinical Vascularized Composite Allotransplantation Program: Requirements and Recommendations
2016Co-Authors: Shari Lawson, Michael R. Davis, C. Anton Fries, Lin Wang, Vijay S. GorantlaAbstract:Vascularized Composite Allotransplantation (VCA) can achieve close to optimal aesthetic restoration of devastating tissue defects not amenable to conventional reconstruction, with improved functional outcomes and avoidance of multiple surgeries or donor site morbidity. During the past decade, more than 50 VCA programs have been established around the world, performing more than 150 VCA procedures including over 100 upper extremity and 30 facial transplants. Clinical VCA requires a multidisciplinary team of providers with extensive experience in issues faced by patients with complex trauma. The VCA team should thus include hand, plastic, orthopedic, head and neck, and transplant surgeons; internists; physical therapists; psychiatrists; pharmacists, and anesthesiologists. In addition, the transplant coordinator, social workers, caregivers, and patient advocates play an important role. This is a comprehensive overview of the key prerequisites for the planning and establishment of a successful clinical VCA program. It highlights the preapproval; personnel; procedures; preoperative, perioperative, and postoperative protocols and procedures; required infrastructure; resources; psychosocial, pharmacologic, and physical therapies involved in patient selection, and management and procurement aspects that are critical components of a VCA program. Key aspects of VCA programs that are discussed include media and public relations, regulatory and fiscal considerations, and ethical concerns.
Gerald Brandacher - One of the best experts on this subject based on the ideXlab platform.
-
Current and future regulatory and financial challenges in Vascularized Composite Allotransplantation.
Current opinion in organ transplantation, 2020Co-Authors: Carisa M. Cooney, Gerald BrandacherAbstract:PURPOSE OF REVIEW To discuss current and future regulatory and financial issues affecting the field of Vascularized Composite Allotransplantation (VCA). RECENT FINDINGS Vascularized Composite allografts are regulated by the US Department of Health and Human Services Organ Procurement and Transplantation Network Final Rule (42 CFR part 121) in the United States and Directive 2010/53/EU of the European Parliament and the Council of 7 July 2010 in the European Union (EU). However, in the United States and most of the EU, VCA is not yet paid for by insurance or third-party payers and many centers depend upon grant funding, philanthropic gifts, and/or supplemental hospital/institutional funding strategies to pay for the transplants and postoperative care. SUMMARY In the absence of randomized clinical trial data, which is infeasible for studying VCA outcomes, consensus data sets are needed to document these procedures' value proposition and have them accepted as part of the standard of care. Procedure and immunosuppression protocol variability applied to a small patient cohort necessitates collaborative efforts by field experts to devise creative approaches, such as determining return-on-investment for anatomical subunits, to better understand these transplants' value and impact on patient quality-of-life.
-
Defining chronic rejection in Vascularized Composite Allotransplantation-The American Society of Reconstructive Transplantation and International Society of Vascularized Composite Allotransplantation chronic rejection working group: 2018 American Soc
SAGE open medicine, 2020Co-Authors: Christina L. Kaufman, Gerald Brandacher, Jean Kanitakis, Annemarie Weissenbacher, Mandeep R. Mehra, Hatem Amer, Bettina Zelger, Bohdan Pomahac, Sue V. McdiarmidAbstract:Objectives:This report summarizes a collaborative effort between the American Society of Reconstructive Transplantation and the International Society of Vascularized Composite Allotransplantation t...
-
Trauma-induced Rejection in Vascularized Composite Allotransplantation.
Annals of surgery, 2020Co-Authors: Joanna W. Etra, Gerald Brandacher, Jaimie T. Shores, Inbal B Sander, W. P. Andrew LeeAbstract:: Vascularized Composite Allotransplantation (VCA) is a relatively new field in reconstructive medicine. Likely a result of the unique tissue composition of these allografts-including skin and often a bone marrow component-the immunology and rejection patterns do not always mimic those of the well-studied solid organ transplantations. While the number and type of VCAs performed is rapidly expanding, there is still much to be discovered and understood in the field. With more patients, new findings and patterns emerge and add to our understanding of VCA. Here, we present a case report of an upper extremity transplant recipient with trauma-induced rejection.
-
Evolving ethics, policy and reimbursement issues of Vascularized Composite Allotransplantation: Symposium summary.
SAGE open medicine, 2019Co-Authors: John Rose, Simon G. Talbot, Jaimie T. Shores, Carisa M. Cooney, Christina Kaufman, Arthur L. Caplan, Jeffrey P. Kahn, Jeremy Sugarman, L. Scott Levin, Gerald BrandacherAbstract:In this article, we present a report from a national meeting titled, "Evolving Issues of Vascularized Composite Allotransplantation-A Symposium on Ethics, Policy, and Reimbursement Issues," which convened in September 2017. We discuss the maturation of Vascularized Composite Allotransplantation from an emerging technology to becoming an extension of clinical practice for select patients with complex reconstructive needs. Viewpoints and action items were presented by and discussed among the 70+ clinicians, researchers, policymakers, ethicists, healthcare administrators, and third-party payers who attended the symposium with the goals of implementing a collaborative roadmap for Vascularized Composite Allotransplantation growth, evaluation, and sustainability by establishing a unified plan to help address concerns of the public, policymakers, and healthcare finance. We review the current status of Vascularized Composite Allotransplantation in clinical practice and summarize symposium discussions regarding ethical considerations, reimbursement, payer strategies, and standardization of data collection.
-
the urogenital epithelium and corporal tissues are the primary targets of rejection in penile Vascularized Composite Allotransplantation a new real time tissue based monitoring system
Plastic and Reconstructive Surgery, 2019Co-Authors: Denver M. Lough, Gerald Brandacher, Edward W. Swanson, Nikolai A. Sopko, Trinity J. Bivalacqua, Arthur L. Burnett, Hotaka Matsui, Devin Miller, Rachel Bluebondlangner, Richard J. RedettAbstract:BACKGROUND: Although significant surgical advances have been made in the form of microvascular surgery and autologous free tissue transfer, penile reconstruction still poses several difficult challenges. Although interest in penile Vascularized Composite Allotransplantation has grown since the first attempted transplant in 2006, little is known regarding the kinetics of rejection and subsequent function of penile allografts. The penis contains multiple tissue types that are not qualified by the Banff 2007 Vascularized Composite Allotransplantation classification system, including urogenital mucosal epithelium and erectile tissues. In this study, the authors investigate the propagation of rejection and the resultant function following rejection in rat and human penile tissues. METHODS: Rejected human and rat penile tissues were examined using an ex vivo real-time tissue-based derivative of the classic mixed lymphocyte reaction assay to determine the interactions occurring between en bloc penile tissues and peripheral blood mononuclear cells (autologous and allogeneic). Correlative in vivo heterotopic rat penile Vascularized Composite Allotransplantation was used to correlate ex vivo findings. RESULTS: In both human and rat ex vivo systems and in vivo rat Vascularized Composite Allotransplantation, the urethral mucosa was the first to undergo rejection-associated apoptosis. The urethral mucosa was the most immunogenic and led to the highest level of peripheral blood mononuclear cell proliferative generations in all systems, whereas the neural tissues of the penis remained immune privileged. CONCLUSION: These findings are the first to describe the kinetics of rejection in both human and rat penile Vascularized Composite Allotransplantation and that the urethral mucosa is the most antigenic, suffering the highest level of rejection-associated apoptosis and peripheral blood mononuclear cell proliferative aggregation.
Curtis L. Cetrulo - One of the best experts on this subject based on the ideXlab platform.
-
genitourinary Vascularized Composite Allotransplantation a review of penile transplantation
Current Opinion in Organ Transplantation, 2019Co-Authors: Michael M Jonczyk, Philipp Tratnigfrankl, Curtis L. CetruloAbstract:PURPOSE OF REVIEW Vascularized Composite Allotransplantation (VCA) has developed over the past 20 years, resulting in promising new reconstructive prospects for extensive soft tissue defects. More than 200 VCAs have been performed worldwide, including five genitourinary (GU)VCAs and here we review the most recent literature in this field. RECENT FINDINGS Developments in GUVCA are continuously evolving to improve patient outcomes and suggest ethical equivalency to solid organ transplant. Recent treatment options have focused on preventing GUVCA complications by acknowledging the immunogenic tissue composition of the penis to treat rejection episodes and implementing stem cell transplant to recognized the GUVCA as self. Utilizing modern, postoperative, treatments can minimize complications and although the ethical dilemma remains, the morality of performing a GUVCA has diminished. The ethical focus relic's on standardization of patient safety. SUMMARY GUVCA has become an established reconstructive surgical option. The prospect of VCA's future insinuates systemization between multidisciplinary VCA programs and the United Network for Organ Sharing in efforts to endorse ethical standardization. Over the last five years, the unprecedented outcomes have shown purpose to GUVCA that initiates an obligation to help those with severe genitourinary tissue defects. Progress in immunobiology continues to evolve optimal immunosuppression drug regimens and tolerance induction protocols, highlighting potential new immunologic pathways for graft acceptance.
-
Vascularized Composite Allotransplantation an emerging concept for burn reconstruction
Journal of Burn Care & Research, 2017Co-Authors: Alexandre G Lellouch, Tessa Drijkoningen, Irene A Chang, David H Sachs, Curtis L. CetruloAbstract:Vascularized Composite Allotransplantation (VCA) has demonstrated utility in the reconstruction of extensive soft-tissue defects following severe burns. However, pre-VCA events such as multiple transfusions, previous transplantation and pregnancies, the use of skin allografts, and mechanical support devices may result in sensitization and ultimately exclude a burn patient, who may benefit most through VCA, from a hand or face transplant. The authors sought to identify the immunologic challenges involved. All reported VCA cases up to July 2016 were reviewed. Relevant data analyzed include patient demographics, burn etiology, type and extent of VCA performed, pretransplant panel reactive antibody (PRA) status, extent of human leukocyte antigen (HLA) mismatch between donor and recipient, and immunologic outcomes. Of the 142 known cases of VCA to date, 30 (mean age = 36 years) were performed for burn reconstruction (mean interval to surgery = 8.3 years). Thermal and electrical burns were most common and performed in 20 and 30% of all reported upper extremity and craniofacial VCA cases, respectively, despite highly variable pretransplant PRA (0-98%). HLA-matching statuses between donors and recipients varied from 2/6 to 6/6. No obvious relationship could be observed between the incidence and severity of acute rejection with the patient's PRA and HLA-matching statuses, although more extensive treatment was required to reverse rejection episodes in sensitized patients (PRA > 0%). Further development and refinement of clinically relevant immunomodulatory protocols is required to achieve immunosuppression minimization and/or successful transplantation tolerance to enable long-term survival of both the VCA itself and the patient.
-
The Advent of Vascularized Composite Allotransplantation
Clinics in plastic surgery, 2017Co-Authors: Curtis L. Cetrulo, Jonathan M. Winograd, Kyle R. EberlinAbstract:Modern microsurgical techniques have made possible a broad spectrum of novel means for the reconstruction of complex bone and soft tissue defects. These techniques, in combination with developments in transplant immunology, have led to successful hand and facial Allotransplantation and achievement of the highest rung in the reconstructive ladder - truly replacing like with like. The utilization of contemporary microsurgical technique in the context of Vascularized Composite Allotransplantation (VCA) (1) permits successful technical execution and feasibility of VCA, (2) facilitates the study of immunologic tolerance in VCA preclinical models, and (3) optimizes functional VCA outcomes.
-
Memory T Cells in Vascularized Composite Allotransplantation
Vascularized Composite Allotransplantation, 2015Co-Authors: Charlotte Read, Josef M Kurtz, Curtis L. CetruloAbstract:Memory T cells are generated as part of the body's primary immune response to infection and environmental exposure so that a primed and more rapid response can be mounted in subsequent encounters. While beneficial in response to subsequent pathogen exposures, the unique characteristics of memory T cells such as their longevity, distinct trafficking patterns to multiple body sites, and cross-reactivity with donor antigens, have been demonstrated to represent a formidable barrier to successful transplantation and tolerance induction in both animal research models and clinical studies. In the context of Vascularized Composite Allotransplantation (VCA) where acute rejection episodes are frequent despite chronic immunosuppression, current research efforts are directed toward immunosuppression minimization or complete withdrawal of immunosuppression through the attainment of transplantation tolerance. This review focuses on the potential roles of memory T cells on the rejection process at the level of the skin ...
-
Vascularized Composite Allotransplantation towards tolerance and the importance of skin specific immunobiology
Current Opinion in Organ Transplantation, 2013Co-Authors: David A Leonard, Josef Kurtz, Curtis L. CetruloAbstract:Purpose of review Vascularized Composite Allotransplantation (VCA) is increasingly utilized in the restoration of complex injuries and tissue loss. Acute skin-targeted rejection episodes are common and concerns remain regarding the risks of conventional immunosuppression. We review current immunosuppressive regimens for VCA, progress with immunomodulatory and tolerance protocols, and highlight recent advances in cutaneous immunobiology which will have significant implications for future development in the field. Recent findings Advances in induction protocols have demonstrated effective prevention of early graft loss in hand transplantation, although long-term outcomes are still pending. Furthermore, recent findings in leukocyte populations within the skin and their mechanisms of communication reveal that considerable numbers of resident T-effector memory cells, including a T-regulatory subset, exist, and that epidermal Langerhans' cells communicate with these cells, mediating both immunity and tolerance to maintain skin homeostasis. Summary The majority of VCA centers utilize antibody-mediated induction, followed by double or triple-agent maintenance immunosuppression. A clinical trial of a minimal-immunosuppression protocol based on bone marrow infusion reports encouraging interim results, but long-term follow-up will be required. Skin remains the primary target of rejection in VCA. New data demonstrate extensive T-cell memory resident in skin, and complex interactions between these cells and epidermal Langerhans' cells will have implications for VCA rejection and tolerance, and warrant further investigation in the allogeneic setting.
Christina L. Kaufman - One of the best experts on this subject based on the ideXlab platform.
-
Evolution of the rat hind limb transplant as an experimental model of Vascularized Composite Allotransplantation: Approaches and advantages.
SAGE open medicine, 2020Co-Authors: Yoram Fleissig, Jason E. Beare, Amanda J. Leblanc, Christina L. KaufmanAbstract:As clinical experience with surgical techniques and immunosuppression in Vascularized Composite Allotransplantation recipients has accumulated, Vascularized Composite Allotransplantation for hand and face have become standard of care in some countries for select patients who have experienced catastrophic tissue loss. Experience to date suggests that clinical Vascularized Composite Allotransplantation grafts undergo the same processes of allograft rejection as solid organ grafts. Nonetheless, there are some distinct differences, especially with respect to the immunologic influence of the skin and how the graft is affected by environmental and traumatic insults. Understanding the mechanisms around these similarities and differences has the potential to not only improve Vascularized Composite Allotransplantation outcomes but also outcomes for all types of transplants and to contribute to our understanding of how complex systems of immunity and function work together. A distinct disadvantage in the study of upper extremity Vascularized Composite Allotransplantation recipients is the low number of clinical transplants performed each year. As upper extremity transplantation is a quality of life rather than a lifesaving transplant, these numbers are not likely to increase significantly until the risks of systemic immunosuppression can be reduced. As such, experimental models of Vascularized Composite Allotransplantation are essential to test hypotheses regarding unique characteristics of graft rejection and acceptance of Vascularized Composite Allotransplantation allografts. Rat hind limb Vascularized Composite Allotransplantation models have been widely used to address these questions and provide essential proof-of-concept findings which can then be extended to other experimental models, including mice and large animal models, as new concepts are translated to the clinic. Here, we review the large body of rat hind limb Vascularized Composite Allotransplantation models in the literature, with a focus on the various surgical models that have been developed, contrasting the characteristics of the specific model and how they have been applied. We hope that this review will assist other researchers in choosing the most appropriate rat hind limb transplantation model for their scientific interests.
-
Defining chronic rejection in Vascularized Composite Allotransplantation-The American Society of Reconstructive Transplantation and International Society of Vascularized Composite Allotransplantation chronic rejection working group: 2018 American Soc
SAGE open medicine, 2020Co-Authors: Christina L. Kaufman, Gerald Brandacher, Jean Kanitakis, Annemarie Weissenbacher, Mandeep R. Mehra, Hatem Amer, Bettina Zelger, Bohdan Pomahac, Sue V. McdiarmidAbstract:Objectives:This report summarizes a collaborative effort between the American Society of Reconstructive Transplantation and the International Society of Vascularized Composite Allotransplantation t...
-
Current Status of Vascularized Composite Allotransplantation.
The American surgeon, 2019Co-Authors: Christina L. Kaufman, Allan Ramirez, Neal Bhutiani, Huey Y. Tien, Michelle D Palazzo, Elkin Galvis, Scott Farner, Tuna Ozyurekoglu, Christopher M. JonesAbstract:The field of Vascularized Composite Allotransplantation (VCA) has moved from a highly experimental procedure to, at least for some patients, one of the best treatment alternatives for catastrophic tissue loss or dysfunction. Although the worldwide experience is still limited, progress has been made in translation to the clinic, and hand transplantation was recently designated standard of care and is now covered in full by the British Health System. This progress is tempered by the long-term challenges of systemic immunosuppression, and the rapidly evolving indications for VCA such as urogenital transplantation. This update will cover the state of and recent changes in the field, and an update of the Louisville VCA program as our initial recipient, the first person to receive a hand transplant in the United States celebrates the 20th anniversary of his transplant. The achievements and complications encountered over the last two decades will be reviewed. In addition, potential directions for research and collaboration as well as practical issues of how third party payers and funding are affecting growth of the field are presented.
-
Adipose-derived cellular therapies in solid organ and Vascularized-Composite Allotransplantation.
Current opinion in organ transplantation, 2017Co-Authors: Katlin B. Stivers, Jason E. Beare, Christina L. Kaufman, Paula M. Chilton, Stuart K. Williams, James B. HoyingAbstract:Purpose of reviewControlling acute allograft rejection following Vascularized Composite Allotransplantation requires strict adherence to courses of systemic immunosuppression. Discovering new methods to modulate the alloreactive immune response is essential for widespread application of Vascularized
-
Monitoring and long-term outcomes in Vascularized Composite Allotransplantation.
Current opinion in organ transplantation, 2013Co-Authors: Christina L. Kaufman, Rosemary Ouseph, Michael R. Marvin, Yorell Manon-matos, Brenda Blair, Joseph E. KutzAbstract:Purpose of review The field of Vascularized Composite Allotransplantation (VCA) is young, with less than 150 transplants worldwide. However, we now possess as much as 14 years of clinical follow-up. There are similarities and distinct differences between solid-organ transplantation (SOT) and VCA. This review will summarize how VCA recipients are monitored, outcomes observed, and what aspects are unique to VCA. Recent findings Of about 90 documented cases, 10% of VCA recipients are out more than 10 years and 14% are out 5 or more years. There have been both graft losses and patient mortality. In most cases, these losses have been acute, most within the first year, and all within 3 years. Unlike SOT, VCA grafts function well during severe rejection. Chronic rejection-like sequelae are less frequent than in SOT, but do appear. Immunosuppression ranges from standard protocols to novel trials aimed at immunosuppression minimization. Patient selection greatly affects the outcome. Graft loss after year 1 is associated with compliance issues. Summary Functional outcomes have exceeded expectations. VCA recipients enjoy a quality of life not achievable with conventional reconstruction. Outstanding long-term results of more than a decade have been achieved. Monitoring of VCA patients will require new strategies to incorporate external visualization and effects of environment on rejection. Graft loss has occurred early, suggesting we focus improvement on this time period. More follow-up is needed to determine the rates and targets of chronic rejection, and the characteristics of VCA unique to face vs. hand transplantation.
Ronald M. Zuker - One of the best experts on this subject based on the ideXlab platform.
-
Pediatric Upper Extremity Vascularized Composite Allotransplantation—Progress and Future
Current Transplantation Reports, 2020Co-Authors: Kevin J. Zuo, Randi Zlotnik Shaul, Gregory H Borschel, Anna Gold, Ronald M. ZukerAbstract:Since 1998, over 120 upper extremity transplants have been successfully performed around the world; however, the field of Vascularized Composite Allotransplantation (VCA) continues to face various medical challenges and ethical controversies. This article summarizes the worldwide experience with transplantation of Vascularized Composite upper extremities in children and discusses the unique considerations facing potential pediatric VCA recipients. Three children have successfully received Composite upper or lower extremity transplants, of which two involved isografts and one involved allografts. Numerous research and clinical advances relevant to VCA have been made, including patient screening, perioperative rehabilitation, allograft preservation and transportation, enhancement of nerve regeneration, understanding of cortical plasticity, and immunomodulatory strategies. Ethical and psychosocial issues remain at the forefront when evaluating potential pediatric VCA recipients. For ethically and rigorously screened pediatric patients with debilitating upper extremity absence, VCA is a compelling option to restore form and function and has a promising future.
-
pediatric upper extremity Vascularized Composite Allotransplantation progress and future
Current Transplantation Reports, 2020Co-Authors: Kevin J. Zuo, Randi Zlotnik Shaul, Gregory H Borschel, Anna Gold, Ronald M. ZukerAbstract:Since 1998, over 120 upper extremity transplants have been successfully performed around the world; however, the field of Vascularized Composite Allotransplantation (VCA) continues to face various medical challenges and ethical controversies. This article summarizes the worldwide experience with transplantation of Vascularized Composite upper extremities in children and discusses the unique considerations facing potential pediatric VCA recipients. Three children have successfully received Composite upper or lower extremity transplants, of which two involved isografts and one involved allografts. Numerous research and clinical advances relevant to VCA have been made, including patient screening, perioperative rehabilitation, allograft preservation and transportation, enhancement of nerve regeneration, understanding of cortical plasticity, and immunomodulatory strategies. Ethical and psychosocial issues remain at the forefront when evaluating potential pediatric VCA recipients. For ethically and rigorously screened pediatric patients with debilitating upper extremity absence, VCA is a compelling option to restore form and function and has a promising future.
-
Pediatric Upper Extremity Vascularized Composite Allotransplantation—Progress and Future
Current Transplantation Reports, 2020Co-Authors: Kevin J. Zuo, Gregory H Borschel, Anna Gold, Randi Zlotnik Shaul, Ronald M. ZukerAbstract:Purpose of Review Since 1998, over 120 upper extremity transplants have been successfully performed around the world; however, the field of Vascularized Composite Allotransplantation (VCA) continues to face various medical challenges and ethical controversies. This article summarizes the worldwide experience with transplantation of Vascularized Composite upper extremities in children and discusses the unique considerations facing potential pediatric VCA recipients. Recent Findings Three children have successfully received Composite upper or lower extremity transplants, of which two involved isografts and one involved allografts. Numerous research and clinical advances relevant to VCA have been made, including patient screening, perioperative rehabilitation, allograft preservation and transportation, enhancement of nerve regeneration, understanding of cortical plasticity, and immunomodulatory strategies. Ethical and psychosocial issues remain at the forefront when evaluating potential pediatric VCA recipients. Summary For ethically and rigorously screened pediatric patients with debilitating upper extremity absence, VCA is a compelling option to restore form and function and has a promising future.
-
Ethical Issues in Pediatric Vascularized Composite Allotransplantation
Ethical Issues in Pediatric Organ Transplantation, 2016Co-Authors: Randi Zlotnik Shaul, Gregory H Borschel, Jennifer Flynn, Mark D. Hanson, Linda Wright, Ronald M. ZukerAbstract:Vascularized Composite Allotransplantation (VCA) enables improved function and quality of life for those who have lost anatomical parts such as a limb and the relief of profound suffering for those with severe facial disfiguration. VCA differs from vital organ transplantation in two important ways: (1) these transplants are not necessary for recipient survival, impacting risk-benefit ratios; and (2) face and limb transplants are visible and touchable, leading to issues of identity changes, social interaction and psychological adjustments. This chapter will consider the ethical implications of VCA in pediatrics. This chapter will be divided into the following six sections: (1) introduction; (2) the state of the science and experience with VCA; (3) risk-benefit assessment; (4) informed consent (i) donors and donor surrogate decision makers (ii) recipients and recipient surrogate decision makers; (5) establishing a pediatric program (i) recipient selection (ii) allocation; (iii) accountability for surgical innovation and (6) conclusion.
-
Vascularized Composite Allotransplantation an update on medical and surgical progress and remaining challenges
Journal of Plastic Reconstructive and Aesthetic Surgery, 2013Co-Authors: Blake D Murphy, Ronald M. Zuker, Gregory H BorschelAbstract:Summary Background In Vascularized Composite Allotransplantation, multiple types of tissue are transferred from donor to recipient as a single functional unit. This technique has been performed for upper extremity, face, and abdominal wall transplants, among many others. Objective To review the existing cases of face and upper extremity Vascularized Composite Allotransplantation performed to date and to describe the functional outcomes and challenges associated with this new procedure. We also review the immune suppression protocols required for these procedures. Methods A literature review was performed using PubMed and online registries where available to identify patients who have undergone upper extremity and face transplant procedures. These were compiled and cross-referenced to abstracts, conference presentations, and press releases in the media to create a list of procedures performed to date. Results More than seventy patients have undergone upper extremity transplantation with very good functional outcomes routinely achieved. Twenty-five face transplants were identified that have been completed to date and details regarding patient outcome are included. One cases of human face Allotransplantation with pre- and post-operative images is included as an example of what can be achieved with this technique. Conclusions Vascularized Composite Allotransplantation is an emerging field that provides an exciting new avenue for reconstructive procedures and achieves functional and cosmetic outcomes not previously possible with existing techniques. However, it is not without its challenges and considerable work is still required prior to widespread adoption of these new reconstructive techniques.