Details

Autor(en) / Beteiligte

• Kaufman, C. L.
• Ouseph, R.
• Blair, B.
• Kutz, J. E.
• Tsai, T. M.
• Scheker, L. R.
• Tien, H. Y.
• Moreno, R.
• Ozyurekoglu, T.
• Banegas, R.
• Murphy, E.
• Burns, C. B.
• Zaring, R.
• Cook, D. F.
• Marvin, M. R.

Titel

Graft Vasculopathy in Clinical Hand Transplantation

Ist Teil von

• American journal of transplantation, 2012-04, Vol.12 (4), p.1004-1016

Ort / Verlag

Malden, USA: Blackwell Publishing Inc

Erscheinungsjahr

2012

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Allogeneic hand transplantation is now a clinical reality. While results have been encouraging, acute rejection rates are higher than in their solid‐organ counterparts. In contrast, chronic rejections, as defined by vasculopathy and/or fibrosis and atrophy of skin and other tissues, as well as antibody mediated rejection, have not been reported in a compliant hand transplant recipient. Monitoring vascularized composite allograft (VCA) hand recipients for rejection has routinely involved punch skin biopsies, vascular imaging and graft appearance. Our program, which has transplanted a total of 6 hand recipients, has experience which challenges these precepts. We present evidence that the vessels, both arteries and veins may also be a primary target of rejection in the hand. Two of our recipients developed severe intimal hyperplasia and vasculopathy early post‐transplant. An analysis of events and our four other patients has shown that the standard techniques used for surveillance of rejection (i.e. punch skin biopsies, DSA and conventional vascular imaging studies) are inadequate for detecting the early stages of vasculopathy. In response, we have initiated studies using ultrasound biomicroscopy (UBM) to evaluate the vessel wall thickness. These findings suggest that vasculopathy should be a focus of frequent monitoring in VCA of the hand. The authors review six hand transplant recipients with respect to clinical course, immunosuppression and graft vasculopathy, and find that vasculopathy can occur insidiously, arising undetected by conventional vascular imaging techniques or skin biopsies.