title: An integrated view of immune monitoring in vascularized composite allotransplantation.
abstract: Vascularized composite allotransplantation (VCA) has several immunological peculiarities that imply a specific immune monitoring. Here, we provide an integrated view of current procedures of immune monitoring in VCA and potential complementary approaches learned from organ transplantation.
  
  
  
  Because the skin is highly immunogenic and is the main target of the alloimmune response, immune monitoring in VCA essentially relies on visual inspection and pathological examination of for-causes and protocol skin biopsies. Light microscopical and immunohistochemical analyses enable us to identify skin lesions that are characteristic, but not specific, of allograft rejection. Complementary approaches of immunological assessment may assist in reinforcing the diagnosis of rejection and preventing over-immunosuppression or under-immunosuppression. Such approaches can inform either on the patient's global immune status or more specifically on the B-cell-mediated or T-cell-mediated immune responses against donor antigens.
  
  
  
  Strategies that integrate both the current 'gold standards' of monitoring in VCA and a complementary multilayer immunological assessment are likely to provide the highest precision for the personalized determination of the recipients' immunological status. The objective is a tailored adaptation of immunosuppressive treatment.
authors: aHospices Civils de Lyon, Hôpital Edouard Herriot, Service de Transplantation, Néphrologie et Immunologie Clinique bINSERM U1111, Centre International de Recherche en Infectiologie (CIRI), Ecole Normale Supérieure de Lyon, CNRS, UMR 5308 cUniversité Lyon 1 dHospices Civils de Lyon, Hôpital Edouard Herriot, Service de Dermatologie eEtablissement Français du Sang, Lyon, France fDepartment of Surgery, University of Cagliari, Cagliari, Italy gHospices Civils de Lyon, Hôpital Edouard Herriot, Service d'urologie et transplantation, Lyon, France.
authors: Antoine
authors: A
authors: Sicard
authors: Jean
authors: J
authors: Kanitakis
authors: Valérie
authors: V
authors: Dubois
authors: Palmina
authors: P
authors: Petruzzo
authors: Lionel
authors: L
authors: Badet
authors: Olivier
authors: O
authors: Thaunat
authors: Emmanuel
authors: E
authors: Morelon
mesh_terms: D006801:Humans; D015166:Monitoring, Immunologic / Q000379:methods*; D063986:Vascularized Composite Allotransplantation / Q000379:methods*