title: A critical analysis of rejection in vascularized composite allotransplantation: clinical, cellular and molecular aspects, current challenges, and novel concepts.
abstract: Advances in microsurgical techniques and immunomodulatory protocols have contributed to the expansion of vascularized composite allotransplantation (VCA) with very encouraging immunological, functional, and cosmetic results. Rejection remains however a major hurdle that portends serious threats to recipients. Rejection features in VCA have been described in a number of studies, and an international consensus on the classification of rejection was established. Unfortunately, current available diagnostic methods carry many shortcomings that, in certain cases, pose a great diagnostic challenge to physicians especially in borderline rejection cases. In this review, we revisit the features of acute skin rejection in hand and face transplantation at the clinical, cellular, and molecular levels. The multiple challenges in diagnosing rejection and in defining chronic and antibody-mediated rejection in VCA are then presented, and we finish by analyzing current research directions and novel concepts aiming at improving available diagnostic measures.
authors: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine , Baltimore, MD , USA.
authors: Karim A
authors: KA
authors: Sarhane
authors: Sami H
authors: SH
authors: Tuffaha
authors: Justin M
authors: JM
authors: Broyles
authors: Amir E
authors: AE
authors: Ibrahim
authors: Saami
authors: S
authors: Khalifian
authors: Pablo
authors: P
authors: Baltodano
authors: Gabriel F
authors: GF
authors: Santiago
authors: Mohammed
authors: M
authors: Alrakan
authors: Zuhaib
authors: Z
authors: Ibrahim
keywords: Banff classification; hand/face transplantation; reconstructive transplantation; transplant rejection; vascularized composite allotransplantation