Skin Immunology and Rejection in VCA and Organ Transplantation
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VASCULARIZED COMPOSITE ALLOGRAFTS (V GORANTLA, SECTION EDITOR)
Skin Immunology and Rejection in VCA and Organ Transplantation D. A. Leonard 1,2 & K. R. Amin 3
&
H. Giele 4 & J. E. Fildes 5,6 & Jason K. F. Wong 3,5,6
Accepted: 23 October 2020 # The Author(s) 2020
Abstract Purpose of Review Skin provides a window into the health of an individual. Using transplanted skin as a monitor can provide a powerful tool for surveillance of rejection in a transplant. The purpose of this review is to provide relevant background to the role of skin in vascularized transplantation medicine. Recent Findings Discrete populations of T memory cells provide distributed immune protection in skin, and cycle between skin, lymph nodes, and blood. Skin-resident TREG cells proliferate in response to inflammation and contribute to long-term VCA survival in small animal models. Early clinical studies show sentinel flap rejection to correlate well with facial VCA skin rejection, and abdominal wall rejection demonstrates concordance with visceral rejection, but further studies are required. Summary This review focuses on the immunology of skin, skin rejection in vascularized composite allografts, and the recent advances in monitoring the health of transplanted tissues using distant “sentinel” flaps. Keywords Skin . Sentinel skin flaps . Immunology . Vascularized composite allotransplantation . VCA
Introduction Vascularized composite allotransplantation (VCA) has become an established option for the restoration of form and function following complex injury or when specialized functional tissues are devitalized. This applies for highly selected cases where conventional, autologous techniques are insufficient to meet such reconstructive requirements. When This article is part of the Topical Collection on Vascularized Composite Allografts * Jason K. F. Wong [email protected] 1
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, UK
2
Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
3
Department of Plastic and Reconstructive Surgery, Manchester University NHS Foundation Trust, Manchester, UK
4
Nuffield Department of Surgery, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
5
Division of Cell Matrix Biology and Regenerative Medicine, Blond McIndoe Laboratories, University of Manchester, 3.104 Stopford Building, Oxford Road, Manchester M13 9TP, UK
6
The Transplant Centre, Manchester University NHS Foundation Trust, Manchester, UK
compared to solid organ transplantation (SOT), VCA recipients can expect to experience a higher incidence of acute rejection, with approximately 85% experiencing one or more episodes during their first post-transplant year [1]. The primary site of VCA acute rejection is most often the skin [2], which is highly immunogenic and susceptible to recipient immune responses, compared to other VCA tissues (historically skin transplantation has been used as a rigorous challenge for immunosuppressive or transplant tolerance protocols [3])
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