Unique Immunological Features of Vascularized Composite Allografts
Vascularized composite allotransplantation (VCA) has emerged as a viable clinical procedure in the past decade. The immunology of VCA remains to be fully investigated and holds much promise to impact the larger field of solid organ transplantation. The initial data suggest that the rate of acute cellular rejection following VCA is higher than seen in solid organs. Yet, the majority of these events are amenable to early diagnosis and completely reversible with timely intervention. Surprisingly, the incidence of chronic rejection in VCA appears to be lower than seen in solid organs. This and other aspects including the role of humoral immunity, ischemia-reperfusion injury, and the significance of donor hematopoietic tissue in VCA grafts will need further study to improve our understanding of VCA. This chapter briefly discusses our current understanding of immunological aspects of VCA.
