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Rajan S, Abraham A, Suresh S, Kumar N. Anesthetic management of bilateral upper extremity allotransplantation. Indian J Transplant 2021. [DOI: 10.4103/ijot.ijot_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Datta N, Devaney SG, Busuttil RW, Azari K, Kupiec-Weglinski JW. Prolonged Cold Ischemia Time Results in Local and Remote Organ Dysfunction in a Murine Model of Vascularized Composite Transplantation. Am J Transplant 2017; 17:2572-2579. [PMID: 28371289 DOI: 10.1111/ajt.14290] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/01/2017] [Accepted: 03/19/2017] [Indexed: 01/25/2023]
Abstract
Vascularized composite allotransplantation (VCA) is a viable reconstructive option for complex tissue defects. Although grafts with a large muscular component may be uniquely susceptible to ischemia-reperfusion (I/R) syndrome, the safe cold ischemia time in VCA has not been established. We investigated the effects of cold ischemia on innate immune response and recipient survival in a murine orthotopic hindlimb transplantation model. Surprisingly, mice receiving grafts exposed to 6 h or longer of cold storage demonstrated reduced survival and massive elevations in serum creatinine, blood urea nitrogen, and creatine kinase, compared with 1 h of cold storage recipients. This was accompanied by progressive increase in macrophage and neutrophil cell infiltration in muscle biopsy specimens, altered platelet endothelial cell adhesion molecule-1 expression, and ultimate renal injury. Multiplex immunoassay analysis identified 21 cytokines in serum and 18 cytokines in muscle biopsy specimens that are likely essential in the complex response to I/R-triggered injury in VCA. In conclusion, this study, in a mouse model of orthotopic hindlimb transplantation, is the first to document that prolonged cold ischemia triggers progressive I/R injury with vascular endothelial damage and may lead to irrecoverable local and remote organ damage. These experimental findings are important in guiding future therapies for human VCA recipients.
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Affiliation(s)
- Neha Datta
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - S G Devaney
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - R W Busuttil
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - K Azari
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - J W Kupiec-Weglinski
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA
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Abstract
The objective of this review is to summarize the collective knowledge regarding the risks and complications in vascularized composite tissue allotransplantation (VCA), focusing on upper extremity and facial transplantation. The field of VCA has entered its second decade with an increasing experience in both the impressive good outcomes, as well as defining challenges, risks, and experienced poor results. The limited and selective publishing of negative outcomes in this relatively new field makes it difficult to conclusively evaluate outcomes of graft and patient survival and morbidities. Therefore, published data, conference proceedings, and communications were summarized in an attempt to provide a current outline of complications. These data on the medical complications of VCA should allow for precautions to avoid poor outcomes, data to better provide informed consent to potential recipients, and result in improvements in graft and patient outcomes as VCA finds a place as a therapeutic option for selected patients.
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Affiliation(s)
- Mehmet C. Uluer
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Philip S. Brazio
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Jhade D. Woodall
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Arthur J. Nam
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Stephen T. Bartlett
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
| | - Rolf N. Barth
- Department of Surgery, Division of Transplantation, University of Maryland School of Medicine, 29 S Greene Street STE 200, Baltimore, MD 21201 USA
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Affiliation(s)
- Sunil Rajan
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ramanathan Kannan Suppiah
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jerry Paul
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Lakshmi Kumar
- Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Edtinger K, Yang X, Uehara H, Tullius SG. Current status of vascularized composite tissue allotransplantation. Burns Trauma 2014; 2:53-60. [PMID: 27602363 PMCID: PMC5012023 DOI: 10.4103/2321-3868.130184] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/09/2014] [Indexed: 01/01/2023]
Abstract
Vascularized composite tissue allotransplantation (VCA) offers treatment options of complex functional deficiencies that cannot be repaired with conventional reconstructive methods. VCAs consist of blocks of functional units comprising different tissue types such as skin, bone, muscle, nerves, blood vessels, tendons, ligaments and others, and are thus substantially different from the composition of organ transplants. The field of VCA has made fascinating progresses in the recent past. Among other VCAs, numerous successful hand, face and limb transplants have been performed in the world. At the same time, specific questions in regard to innate and adaptive immunity, consequences of ischemia/reperfusion injury, immunosuppression, preservation, and regenerative capacity remain. In spite of this, the field is poised to make significant advances in the near future.
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Affiliation(s)
- Karoline Edtinger
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA ; Department of Surgery, University Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Xiaoyong Yang
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA ; Division of Urology, Bejing Chao-Yang Hospital, Capital Medical University, Bejing, China
| | - Hanae Uehara
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA ; Department of Plastic and Reconstructive Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Stefan G Tullius
- Division of Transplant Surgery and Laboratory of Transplant Surgery Research, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, Massachusetts 02115 USA
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Barret JP. From partial to full-face transplantation: Total ablation and restoration, a change in the reconstructive paradigm. Int J Surg 2014; 12:109-12. [DOI: 10.1016/j.ijsu.2013.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 10/30/2013] [Accepted: 11/16/2013] [Indexed: 11/19/2022]
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Murphy BD, Zuker RM, Borschel GH. Vascularized composite allotransplantation: an update on medical and surgical progress and remaining challenges. J Plast Reconstr Aesthet Surg 2013; 66:1449-55. [PMID: 23867239 DOI: 10.1016/j.bjps.2013.06.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 06/02/2013] [Accepted: 06/18/2013] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- Blake D Murphy
- University of Toronto, Division of Plastic and Reconstructive Surgery, Toronto, Canada
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Infante-Cossio P, Barrera-Pulido F, Gomez-Cia T, Sicilia-Castro D, Garcia-Perla-Garcia A, Gacto-Sanchez P, Hernandez-Guisado JM, Lagares-Borrego A, Narros-Gimenez R, Gonzalez-Padilla JD. Facial transplantation: a concise update. Med Oral Patol Oral Cir Bucal 2013; 18:e263-71. [PMID: 23229268 PMCID: PMC3613879 DOI: 10.4317/medoral.18552] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 07/07/2012] [Indexed: 11/10/2022] Open
Abstract
Objectives: Update on clinical results obtained by the first worldwide facial transplantation teams as well as review of the literature concerning the main surgical, immunological, ethical, and follow-up aspects described on facial transplanted patients.
Study design: MEDLINE search of articles published on “face transplantation” until March 2012.
Results: Eighteen clinical cases were studied. The mean patient age was 37.5 years, with a higher prevalence of men. Main surgical indication was gunshot injuries (6 patients). All patients had previously undergone multiple conventional surgical reconstructive procedures which had failed. Altogether 8 transplant teams belonging to 4 countries participated. Thirteen partial face transplantations and 5 full face transplantations have been performed. Allografts are varied according to face anatomical components and the amount of skin, muscle, bone, and other tissues included, though all were grafted successfully and remained viable without significant postoperative surgical complications. The patient with the longest follow-up was 5 years. Two patients died 2 and 27 months after transplantation.
Conclusions: Clinical experience has demonstrated the feasibility of facial transplantation as a valuable reconstructive option, but it still remains considered as an experimental procedure with unresolved issues to settle down. Results show that from a clinical, technical, and immunological standpoint, facial transplantation has achieved functional, aesthetic, and social rehabilitation in severely facial disfigured patients.
Key words:Face transplantation, composite tissue transplantation, face allograft, facial reconstruction, outcomes and complications of face transplantation.
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Affiliation(s)
- Pedro Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, Seville, Spain.
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Leonard DA, Mastroianni M, Shanmugarajah K, Cetrulo CL. Concomitant Face/Upper Extremity Allotransplantation. Curr Surg Rep 2013; 1:53-59. [DOI: 10.1007/s40137-012-0005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sicilia-castro D, Gomez-cia T, Infante-cossio P, Gacto-sanchez P, Barrera-pulido F, Lagares-borrego A, Narros-gimenez R, Garcia-perla A, Hernandez-guisado J, Gonzalez-padilla J. Reconstruction of a Severe Facial Defect by Allotransplantation in Neurofibromatosis Type 1: A Case Report. Transplant Proc 2011; 43:2831-7. [DOI: 10.1016/j.transproceed.2011.06.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 05/12/2011] [Accepted: 06/03/2011] [Indexed: 11/19/2022]
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Shanmugarajah K, Hettiaratchy S, Clarke A, Butler PE. Clinical outcomes of facial transplantation: A review. Int J Surg 2011; 9:600-7. [DOI: 10.1016/j.ijsu.2011.09.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 09/13/2011] [Accepted: 09/25/2011] [Indexed: 11/25/2022]
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