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Huchon L, Badet L, Roy AC, Finos L, Gazarian A, Revol P, Bernardon L, Rossetti Y, Morelon E, Rode G, Farnè A. Grasping objects by former amputees: The visuo-motor control of allografted hands. Restor Neurol Neurosci 2018; 34:615-33. [PMID: 26890093 DOI: 10.3233/rnn-150502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Hand allograft has recently emerged as a therapeutic option for upper limb amputees. Functional neuroimaging studies have progressively revealed sensorimotor cortices plasticity following both amputation and transplantation. The purpose of our study was to assess and characterize the functional recovery of the visuo-motor control of prehension in bilateral hand transplanted patients. METHODS Using kinematics recordings, we characterized the performance of prehension with or without visual feed-back for object of different position and size, in five bilateral hand allograft recipients and age-matched control subjects. Both hands were assessed, separately. RESULTS Despite an overall slower execution, allografted patients succeeded in grasping for more than 90% of the trials. They exhibited a preserved hand grip scaling according to object size, and preserved prehension performances when tested without visual feedback. These findings highlight the allograft recipients' abilities to produce an effective motor program, and a good proprioceptive-dependent online control. Nevertheless, the maximum grip aperture was reduced and delayed, the coupling between Transport and Grasp components was altered, and the final phase of the movement was lengthened. CONCLUSION Hand allotransplantation can offer recipients a good recovery of the visuo-motor control of prehension, with slight impairments likely attributable to peripheral neuro-orthopedic limitations.
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Affiliation(s)
- Laure Huchon
- ImpAct Team, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Lyon, France.,Physical and Rehabilitation Medicine Department, Mouvement Handicap, Henry Gabrielle Hospital, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, Lyon, France
| | - Lionel Badet
- Claude Bernard Lyon 1 University, Lyon, France.,Transplantation Surgery Department, Edouart Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Livio Finos
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Aram Gazarian
- Orthopaedic Surgery Department, Clinique du Parc Lyon, Lyon, France
| | - Patrice Revol
- ImpAct Team, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Lyon, France.,Physical and Rehabilitation Medicine Department, Mouvement Handicap, Henry Gabrielle Hospital, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, Lyon, France
| | | | - Yves Rossetti
- ImpAct Team, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Lyon, France.,Physical and Rehabilitation Medicine Department, Mouvement Handicap, Henry Gabrielle Hospital, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, Lyon, France
| | - Emmanuel Morelon
- Claude Bernard Lyon 1 University, Lyon, France.,Nephrology and Immunology Department, Edouart Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Gilles Rode
- ImpAct Team, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Lyon, France.,Physical and Rehabilitation Medicine Department, Mouvement Handicap, Henry Gabrielle Hospital, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, Lyon, France
| | - Alessandro Farnè
- ImpAct Team, INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Lyon, France.,Claude Bernard Lyon 1 University, Lyon, France
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Hand Allograft Saved by an Ultrathin Groin Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e869. [PMID: 27757334 PMCID: PMC5055000 DOI: 10.1097/gox.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/04/2016] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. We report a case of a young double-hand allotransplant patient who presented with a full-thickness skin necrosis of the dorsum of the left hand after vascular compromise of the allotransplantation. Considering the lack of viable dorsal tissue overlying the extensor tendons and the need for early hand rehabilitation, an ultrathin pedicled groin flap was used for the coverage. This procedure resulted in salvaging the allotransplantation, and the patient was able to successfully return to work after his surgery. To our knowledge, this is the only case of an upper extremity allotransplant salvaged by a pedicled flap.
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3
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Bilateral hand transplantation: Functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4–13 years). J Plast Reconstr Aesthet Surg 2015; 68:1171-83. [DOI: 10.1016/j.bjps.2015.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 01/10/2023]
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5
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Masquelet AC. [Hand allograft transplantation: what are the implications?]. Presse Med 2013; 42:1650-4. [PMID: 24134816 DOI: 10.1016/j.lpm.2012.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/14/2012] [Accepted: 05/29/2012] [Indexed: 11/25/2022] Open
Abstract
The first hand allograft transplantation was performed in 1998 by a French surgeons team and has opened the era of functional allotransfers. In France, the authorized preliminary study included five patients who sustained traumatic amputation of both hands. All patients had bilateral hand allograft transplantation. Long-term results (follow-up ranging from 3 to 12 years) undoubtedly show a useful daily function, a good psychological acceptance and a physiological integration. Despite several obstacles as the need of immunosuppressive therapy for life, hand allograft transplantation is worthy of interest in some outstanding situations.
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Affiliation(s)
- Alain Charles Masquelet
- Paris-VI, AP-HP, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Radu C, Horn D, Kiefer J, Rebel M, Gebhard M, Ryssel H, Köllensperger E, Fändrich F, Germann G, Kremer T. Donor-derived transplant acceptance-inducing cells in composite tissue allotransplantation. J Plast Reconstr Aesthet Surg 2012; 65:1684-91. [DOI: 10.1016/j.bjps.2012.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 05/15/2012] [Accepted: 07/02/2012] [Indexed: 11/27/2022]
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7
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Radu CA, Kiefer J, Horn D, Kleist C, Dittmar L, Sandra F, Rebel M, Ryssel H, Koellensperger E, Gebhard MM, Lehnhardt M, Germann G, Terness P. Mitomycin-C-treated peripheral blood mononuclear cells (PBMCs) prolong allograft survival in composite tissue allotransplantation. J Surg Res 2012; 176:e95-e101. [PMID: 22445458 DOI: 10.1016/j.jss.2011.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 11/16/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Composite tissue allotransplantation (CTA) was introduced as a potential treatment for complex reconstructive procedures and has become a clinical reality. Hand and face transplantation, the most widely recognized forms of CTA, have intensified immunological research in this emerging field of transplantation. Mitomycin C (MMC) is an alkylating agent that suppresses allogeneic T-cell responses. MMC-treated dendritic cells/PBMCs have been shown to induce donor-specific tolerance in solid organ allograft transplantations. METHODS Fully mismatched rats were used as hind limb donors [Lewis (RT1(1))] and recipients [Brown-Norway (RT1(n))]. Fifty-five allogeneic hind limb transplantations were accomplished in six groups. Group A (n = 10) received donor-derived MMC-treated PBMCs on transplantation day. Group B (n = 10) rats received no immunosuppression, group C (n = 10) received FK506 and prednisolon, group D consisted in isograft transplantation without immunosuppression, group E (n = 10) received non-treated PBMCs, and group F (n = 5) received PBS without any donor-derived cells. Rejection was assessed clinically and histologically. RESULTS In group A, the survival times of the allografts were prolonged to an average of 8.0 d. Rejection was significantly delayed compared with the averages of the corresponding control groups B, E, and F (5.5, 5.9, and 5.8 d). No rejection was seen in control groups C and D. CONCLUSION These results demonstrate that MMC-treated donor PBMCs significantly prolong allograft survival when administered systemically on the day of transplantation. However, the immunomodulatory effect is relatively modest with further research being required to clarify dose-effect relations, cell characteristics, and an optimized mechanism and timing for cell application.
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Affiliation(s)
- Christian Andreas Radu
- Department of Hand, Plastic, and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Germany.
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8
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Landin L, Bonastre J, Casado-Sanchez C, Diez J, Ninkovic M, Lanzetta M, del Bene M, Schneeberger S, Hautz T, Lovic A, Leyva F, García-de-Lorenzo A, Casado-Perez C. Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review. Transpl Int 2012; 25:424-32. [PMID: 22332605 DOI: 10.1111/j.1432-2277.2012.01433.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts. Clinical cases of HAT published between 1999 and 2011 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Infectious, metabolic, and oncological complications because of IS therapy were recorded. Twenty-eight patients were reported in 56 clinical manuscripts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (±19.04) points on the DASH score after HAT (P = 0.005). Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. The presence of intrinsic muscle function was observed in 57% of the recipients. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. Three grafts were lost to follow-up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Fifty-two complications caused by IS agents were reported, and they were successfully managed medically or surgically. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols.
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Affiliation(s)
- Luis Landin
- Division of Plastic and Reconstructive Surgery, University Hospital La Paz, Madrid, Spain.
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World experience after more than a decade of clinical hand transplantation: update on the Polish program. Hand Clin 2011; 27:433-42, viii. [PMID: 22051385 DOI: 10.1016/j.hcl.2011.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It has been demonstrated over the past decade that the generally achieved functional outcomes of patients after hand transplantation (HTx) are better than those of equivalent replantations. However, HTx should be performed in specialized centers with Institutional Review Board-approved transplantation programs. In Poland such requirements are fulfilled by The Subdepartment of Replantation of Limbs of St. Jadwiga Hospital in Trzebnica. A main emphasis of this subdepartment is to make the very involved process of donor recruitment, recipient screening, surgery, and postoperative treatment fully transparent. This article summarizes the experience of this center with HTx over the past 5 years.
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10
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Ravindra KV, Ildstad ST. Immunosuppressive protocols and immunological challenges related to hand transplantation. Hand Clin 2011; 27:467-79, ix. [PMID: 22051388 DOI: 10.1016/j.hcl.2011.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There are many immunological challenges related to hand transplantation. Curbing the immune system's ability to effectively mount an immune response against the graft is the goal. As the various components of the immune response are defined and their mechanisms of action delineated, more specific immunosuppressive agents and protocols have been developed. Complications related to immunosuppression in hand transplant recipients are similar to incidences among solid organ recipients. With longer follow-up, the increased cardiovascular risk factors or the development of a neoplasm will likely cause mortality. Standardizing immunosuppression in hand transplantation with the long-term goal of minimization is critically needed.
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Schneeberger S, Landin L, Jableki J, Butler P, Hoehnke C, Brandacher G, Morelon E. Achievements and challenges in composite tissue allotransplantation. Transpl Int 2011; 24:760-9. [PMID: 21554424 DOI: 10.1111/j.1432-2277.2011.01261.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Overall, more than 60 hand/forearm/arm transplantations and 16 face transplantations have been performed in the past 12 years. In the European experience summarized here, three grafts have been lost in response to a vascular thrombosis (n = 1), rejection and incompliance with immunosuppression (n = 1) and death (n = 1). The overall functional and esthetic outcome is very satisfactory, but serious side effects and complications related to immunosuppression are challenges hindering progress in this field. The high levels of immunosuppression, skin rejection, nerve regeneration, donor legislation and the acceptance level need to be addressed to promote growth of this promising new field in transplantation and reconstructive surgery.
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Affiliation(s)
- Stefan Schneeberger
- Center for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
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Guigal V, Pialat JB, Vilayphiou N, Deshayes E, Rizzo C, Gazarian A. [Bone quality evaluation in allograft hand transplant]. ACTA ACUST UNITED AC 2010; 29 Suppl 1:S199-213. [PMID: 21075662 DOI: 10.1016/j.main.2010.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Five bilateral forearms allograft have been performed between January 2000 and July 2009 in Lyon (France). The first four patients (three males, one female) have been the subject of an assessment of the bone quality of those allografts. The techniques selected for this study were: radioclinical analysis, bone scintigraphy, MRI, bone densitometry and High Resolution peripheral Quantitative Computed Tomography (HR-PQCT). Histology has been performed only on the first patient unilaterally grafted in 1998 who did not take part in this clinical research protocol, after amputation of his rejected graft. On the clinical, radiological and scintigraphical aspects, donor bone integration in hands allograft are good on a macroscopic point of view considering the healing and the general reaction of the bone in situation of fractures, infection and growth. The scintigraphy does not show important variations compared to the ones we can observe on contact with osteosynthesis material or during bone autografts. MRI found neither focal nor periosteal anomaly on grafted bone. The bone densitometry did not show significant difference with secondary osteoporosis one can observe in other grafted patients under immunosuppressive treatment. The HR-PQCT showed for the three males patients, a higher loss in volumetric density, for grafted bone than in the recipient patient control skeleton. Due to the few patients of this series, and the discrepancies in follow-up duration, the presented data have to be confirmed with further studies.
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Affiliation(s)
- V Guigal
- Département de chirurgie de la main, clinique du parc de Lyon, 155 boulevard Stalingrad, Lyon, France.
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Chancholle AR, Souquet R, Moutet F, Saboye J. [Treatment indications for hand agenesis or acquired loss: Standard technics versus allotransplantation (CTA)]. ANN CHIR PLAST ESTH 2010; 55:272-86. [PMID: 20705208 DOI: 10.1016/j.anplas.2009.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 11/07/2009] [Indexed: 11/30/2022]
Abstract
The new surgery thinking, in matter of hand loss, is made of two ways: without hand, there is no more functional abilities; homograft or allograft of hand is the best actual treatment. This is not true and we are able to get new functional abilities by other ways: without any treatment, we are able of spontaneous functional recovery. There are other treatments: the old operation of Krukenberg or new bionic prosthesis. This work is a recall of obvious or forgotten facts.
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[To cure: to become oneself or become different?]. ANN CHIR PLAST ESTH 2010; 55:287-96. [PMID: 20705209 DOI: 10.1016/j.anplas.2009.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 11/07/2009] [Indexed: 11/24/2022]
Abstract
The parallel evolution of lifestyles and medicine calls into question the objectives of the therapeutical relationship. Leading-edge technology, the allotransplant radically questions what curing means: is it about becoming oneself again or another person? This paper studies this dilemma from three standpoints. First, in an aesthetics perspective, the transplant surgery refers to an implicit definition of what is an acceptable body, which introduces a tension between vascular supply, immunology and beauty. How far can we favour one or the other? Secondly, in a religious perspective, transplant contributes to the mimetic desire: how can we regulate this desire in a society that increasingly values the body? Finally, from a philosophical standpoint, allotransplant questions my personal relationship with my body: beyond its technological requirements, we have to determine, in the public and private spheres, if individuals have or are bodies. What responsibility does medicine assume, as an institution and a community of agents, in this anthropological choice?
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Palafox D, Llorente L, Alberú J, Torres-Machorro A, Camorlinga N, Rodríguez C, Granados J. The role of indoleamine 2,3 dioxygenase in the induction of immune tolerance in organ transplantation. Transplant Rev (Orlando) 2010; 24:160-5. [PMID: 20541386 DOI: 10.1016/j.trre.2010.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Accepted: 04/07/2010] [Indexed: 11/25/2022]
Abstract
The aim of this review is to present current information on transplantation research regarding the role of indoleamine 2,3 dioxygenase in immune regulation. We present the basic mechanisms by which the enzyme is expressed, followed by tryptophan catabolism that leads to midg1 phase arrest and apoptosis. Other effects proposed, although not yet completely proven and generally accepted, include T-cell development suppression, secretion of regulatory cytokines such as IL10, and generation of new T regulatory cells. Clinical studies are being performed worldwide; thus, our goal is to focus on the clinical potential relevance of the enzyme rather than a presentation on a molecular basis so that health care providers concerning transplantation are aware of this promising field in immunology and therapeutics. We do emphasize the fact that information regarding the role of indoleamine 2,3 dioxygenase in human beings is still scarce.
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Affiliation(s)
- Damian Palafox
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México D.F., México
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Hautz T, Zelger B, Grahammer J, Krapf C, Amberger A, Brandacher G, Landin L, Müller H, Schön MP, Cavadas P, Lee AWP, Pratschke J, Margreiter R, Schneeberger S. Molecular markers and targeted therapy of skin rejection in composite tissue allotransplantation. Am J Transplant 2010; 10:1200-9. [PMID: 20353468 DOI: 10.1111/j.1600-6143.2010.03075.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Skin rejection remains a major hurdle in reconstructive transplantation. We investigated molecular markers of skin rejection with particular attention to lymphocyte trafficking. Skin biopsies (n = 174) from five human hand transplant recipients were analyzed for rejection, characteristics of the infiltrate and lymphocytic adhesion markers. The cellular infiltrate predominantly comprised CD3+ T cells. CD68, Foxp3 and indoleamine 2, 3-dioxygenase expression and the CD4/CD8 increased with severity of rejection. Lymphocyte adhesion markers were upregulated upon rejection, intercellular adhesion molecule-1 and E-selectin correlated best with severity of rejection. Guided by the findings, a specific E- and P-selectin inhibitor was investigated for its effect on skin rejection in a rat hind limb allotransplant model. While efomycine M (weekly s.c. injection into the graft) alone had no effect, long-term allograft survival was achieved when combined with antithymocyte globulin and tacrolimus (control group without efomycine M rejected at postoperative day [POD] 61 +/- 1). Upregulation of lymphocyte trafficking markers correlates with severity of skin rejection and time after transplantation in human hand transplantation. Blocking E- and P-selectin in the skin holds potential to significantly prolong limb allograft survival.
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Affiliation(s)
- T Hautz
- Department of Visceral, Transplant and Thoracic Surgery, Center for Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
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Ethics and Organ Transfer: A Merleau-Pontean Perspective. HEALTH CARE ANALYSIS 2009; 17:110-22. [DOI: 10.1007/s10728-009-0116-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 02/10/2009] [Indexed: 12/17/2022]
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