title: Characterization, prophylaxis, and treatment of infectious complications in craniomaxillofacial and upper extremity allotransplantation: a multicenter perspective.
abstract: BACKGROUND
  Vascularized composite allotransplants consist of heterogeneous tissues from different germ layers, which include skin, muscle, bone, fat, nerves, and lymph nodes. The antigenic diversity of these tissues, particularly of the highly immunogenic skin component, necessitates potent immunosuppressive regimens similar to that of some solid organ transplants. Indeed, the lifelong, high-dose, multidrug immunosuppressive protocols expose vascularized composite allotransplant recipients to considerable risk of infectious, metabolic, and neoplastic sequelae. In this article, the authors review the infectious risk to patients after vascularized composite allotransplantation, with special attention to the somewhat limited experience with the prophylaxis and treatment of infections after this innovative reconstructive surgery.
  
  
  METHODS
  A review of the literature was undertaken to elucidate the characterization, prophylaxis, and treatment of all documented infectious complications.
  
  
  RESULTS
  Infections in face and hand vascularized composite allotransplants follow a course similar to that of solid organ transplants. Several differences exist, including the unique flora of craniomaxillofacial transplants, the increased risk of donor-derived infections, and the alteration of the risk-to-benefit ratio for cytomegalovirus infections.
  
  
  CONCLUSIONS
  The patient with a face or limb transplant has many of the same infectious risks as a lung transplant recipient, which include bacterial, viral, and fungal infections. Because of the anatomy, mucosal exposure, and differing donor flora, however, the face or limb transplant is susceptible to invasive diseases from a variety of microbes.
authors.affiliation: Baltimore, Md.; Pittsburgh, Pa.; and Boston, Mass. From the Department of Plastic and Reconstructive Surgery and the Division of Infectious Disease, Department of Medicine, The Johns Hopkins Hospital; the Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center; and the Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Harvard Medical School.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Broyles
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alrakan
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ensor
authors.forename: Saami
authors.initials: S
authors.lastname: Khalifian
authors.forename: Camille N
authors.initials: CN
authors.lastname: Kotton
authors.forename: Robin K
authors.initials: RK
authors.lastname: Avery
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
authors.forename: W P Andrew
authors.initials: WPA
authors.lastname: Lee
authors.forename: Chad R
authors.initials: CR
authors.lastname: Gordon
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000628:therapy; D003586:Cytomegalovirus Infections; D054445:Facial Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008437:Maxilla / Q000637:transplantation*; D009894:Opportunistic Infections / Q000453:epidemiology* / Q000628:therapy; D016377:Organ Transplantation; D009960:Oropharynx / Q000382:microbiology; D010256:Paranasal Sinuses / Q000382:microbiology; D063986:Vascularized Composite Allotransplantation / Q000009:adverse effects; D014777:Virus Diseases / Q000453:epidemiology* / Q000628:therapy
chemical_list: D007166:Immunosuppressive Agents