Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013 Oct 8:13:e53.

Split rejection in vascularized composite allotransplantation

Indranil Sinha  1 , Bohdan Pomahac
Affiliations
Review

Split rejection in vascularized composite allotransplantation

Indranil Sinha et al. Eplasty. .

Abstract

Introduction: Graft monitoring following vascularized composite allotransplantation (VCA) relies primarily on serial skin biopsy. However, given that VCA comprised multiple tissue types, skin biopsy may not accurately reflect rejection in other transplanted tissue.

Methods: A review of the literature on episodes of both acute and chronic rejection following VCA was completed. Special attention was given to how these patients were monitored for rejection and whether skin biopsy accurately reflected the state of other tissue types within VCA.

Results: Following VCA, skin biopsies accurately reflected episodes of acute rejection, but chronic rejection, resulting in both muscle fibrosis and graft vasculopathy, did not present with any ostensible skin changes.

Conclusion: Various tissue types within VCA can reject at different times and rates. We define this phenomenon as "split rejection." Split rejection has significant implications on flap monitoring, as it suggests that skin biopsy alone may not be sufficient in monitoring long-term graft rejection.

Keywords: acute rejection; chronic rejection; immunosuppression; split rejection; vascularized composite allotransplantation.

PubMed Disclaimer

References

    1. Kaufman CL, Breidenbach W. World experience after more than a decade of clinical hand transplantation: update from the Louisville hand transplant program. Hand Clin. 2011;27:417–21. - PubMed
    1. Siemionow M, Ozturk C. An update on facial transplantation cases performed between 2005 and 2010. Plast Reconstr Surg. 2011;128:707–20e. - PubMed
    1. Chang J, Davis CL, Mathes DW. The impact of current immunosuppression strategies in renal transplantation on the field of reconstructive transplantation. J Reconstr Microsurg. 2011;28:7–20. - PubMed
    1. Schuind F, Abramowicz D, Schneeberger S. Hand transplantation: the state-of-the-art. J Hand Surg. 2007;32:2–17. - PubMed
    1. Petruzzo P, Lanzetta M, Dubernard JM, et al. The international registry on hand and composite tissue transplantation. Transplantation. 2010;90:1590–4. - PubMed

LinkOut - more resources