title: Vascularized bone marrow-based immunosuppression inhibits rejection of vascularized composite allografts in nonhuman primates.
abstract: Vascularized composite allograft (VCA) transplantation (also referred to as composite tissue allotransplantation) has demonstrated clinical success in cases of hand, arm and face transplantation despite prior belief that skin provides an insurmountable barrier to allograft rejection. These overall good outcomes are facilitated by substantial immunosuppressive requirements in otherwise healthy patients, yet still demonstrate frequent rejection episodes. We developed a nonhuman primate model of facial segment allotransplantation to elucidate the unique pathophysiology and immunosuppressive requirements of VCA with addition of concomitant vascularized bone marrow (VBM). Heterotopically transplanted facial segment VCA with VBM treated only with tacrolimus and mycophenolate mofetil (MMF) demonstrated prolonged rejection-free survival, compared to VCA without VBM that demonstrated early rejection episodes and graft loss. While VCA with VBM demonstrated sporadic macrochimerism, acute and chronic rejection and graft loss occurred after discontinuation of immunosuppression. These data support an immunomodulatory role of VBM in VCA that reduces immunosuppressive requirements while providing improved outcomes.
authors.affiliation: Division of Transplantation, Program for Comparative Medicine Department of Pathology Immunogenetics Laboratory, University of Maryland School of Medicine, Baltimore, MD, USA. rbarth@smail.umaryland.edu
authors.forename: R N
authors.initials: RN
authors.lastname: Barth
authors.forename: E D
authors.initials: ED
authors.lastname: Rodriguez
authors.forename: G S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: A J
authors.initials: AJ
authors.lastname: Nam
authors.forename: J S
authors.initials: JS
authors.lastname: Ha
authors.forename: H
authors.initials: H
authors.lastname: Hui-Chou
authors.forename: L S
authors.initials: LS
authors.lastname: Jones
authors.forename: A
authors.initials: A
authors.lastname: Panda
authors.forename: S T
authors.initials: ST
authors.lastname: Shipley
authors.forename: C B
authors.initials: CB
authors.lastname: Drachenberg
authors.forename: D
authors.initials: D
authors.lastname: Kukuruga
authors.forename: S T
authors.initials: ST
authors.lastname: Bartlett
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000818:Animals; D001853:Bone Marrow / Q000098:blood supply* / Q000187:drug effects; D054445:Facial Transplantation / Q000379:methods; D005260:Female; D006085:Graft Survival / Q000187:drug effects; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008252:Macaca fascicularis; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D018183:Transplantation Chimera; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus