PMID- 28328655
OWN - NLM
STAT- MEDLINE
DCOM- 20180719
LR  - 20180719
IS  - 1559-0488 (Electronic)
IS  - 1559-047X (Linking)
VI  - 38
IP  - 6
DP  - 2017 Nov/Dec
TI  - Vascularized Composite Allotransplantation-An Emerging Concept for Burn 
      Reconstruction.
PG  - 371-378
LID - 10.1097/BCR.0000000000000532 [doi]
AB  - 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.
FAU - Ng, Zhi Yang
AU  - Ng ZY
AD  - From the *Center for Transplantation Sciences, Massachusetts General Hospital, 
      Harvard Medical School; and daggerDivision of Plastic and Reconstructive Surgery, 
      Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
FAU - Lellouch, Alexandre G
AU  - Lellouch AG
FAU - Drijkoningen, Tessa
AU  - Drijkoningen T
FAU - Chang, Irene A
AU  - Chang IA
FAU - Sachs, David H
AU  - Sachs DH
FAU - Cetrulo, Curtis L Jr
AU  - Cetrulo CL Jr
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Burn Care Res
JT  - Journal of burn care & research : official publication of the American Burn 
      Association
JID - 101262774
SB  - IM
MH  - Adult
MH  - Burns/complications/pathology/*surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - *Skin Transplantation
MH  - Treatment Outcome
MH  - *Vascularized Composite Allotransplantation
MH  - Young Adult
EDAT- 2017/03/23 06:00
MHDA- 2018/07/20 06:00
CRDT- 2017/03/23 06:00
PHST- 2017/03/23 06:00 [pubmed]
PHST- 2018/07/20 06:00 [medline]
PHST- 2017/03/23 06:00 [entrez]
AID - 10.1097/BCR.0000000000000532 [doi]
PST - ppublish
SO  - J Burn Care Res. 2017 Nov/Dec;38(6):371-378. doi: 10.1097/BCR.0000000000000532.