title: The abdominal wall transplant as a sentinel skin graft.
abstract: Abdominal wall transplantation is a technique used to achieve abdominal closure after intestinal and multivisceral transplantation. This review focuses on whether there are additional benefits for the skin component as an immune-monitoring tool.
  
  
  
  The largest series of abdominal wall transplants has recently been published. Alongside the physiological advantage gained in abdominal closure, the authors describe the immunological insight that the skin component can provide and how this contributes to the management of patients. The skin appears to develop a rash with early rejection, which facilitates early systemic treatment before significant visceral rejection occurs. It can also help in cases in which there is diagnostic doubt regarding the cause of bowel dysfunction such as in instances of intestinal infection. Despite the additional immunological burden of donor tissue, there appears to be no requirement for increased immunosuppressive therapy.
  
  
  
  The technical and immunological feasibility of abdominal wall transplantation has now been demonstrated by several centres. Skin transplanted as part of the abdominal wall or as a separate vascularized sentinel skin flap may aid in the diagnosis of rejection. This has the potential to improve graft survival and reduce immunosuppressive morbidity.
authors: aOxford Transplant Centre, Oxford University Hospitals NHS Foundation Trust bNuffield Department of Surgical Sciences, University of Oxford cDepartment of Plastic and Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors: James
authors: J
authors: Barnes
authors: Fadi
authors: F
authors: Issa
authors: Georgios
authors: G
authors: Vrakas
authors: Peter
authors: P
authors: Friend
authors: Henk
authors: H
authors: Giele
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D064595:Composite Tissue Allografts / Q000637:transplantation*; D006085:Graft Survival / Q000276:immunology*; D006801:Humans; D016038:Skin Transplantation / Q000379:methods*