Histopathological Syndromes of Vascularized Composite Allograft Rejection and Recurrent Disease
Vascularized composite allotransplantation (VCA) is a developing field for the reconstruction of multi-tissue defects unable to be ameliorated with autologous tissue. Thus far, over 90 patients have received a VCA worldwide. Essentially, all VCA recipients have experienced episodes of rejection. At the time this chapter was written, acute rejection episodes have been observed in up to 85% of VCA recipients within the first year. Due to the infrequent application of VCA, no single group has accumulated sufficient experience to determine histologic patterns of rejection. As such, this chapters focuses on the histopathological aspects of graft rejection within the context of the early stage of VCA development. We also provide a historic perspective of the study of VCA histopathology primed by the Banff Working Group, and considerations on non-alloimmune pathology.
