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Donor-specific antibodies and antibody-mediated rejection in vascularized composite allotransplantation

Weissenbacher, Annemarie; Loupy, Alexandre; Chandraker, Anil; Schneeberger, Stefan

Current Opinion in Organ Transplantation: October 2016 - Volume 21 - Issue 5 - p 510–515
doi: 10.1097/MOT.0000000000000349

Purpose of review The presence of donor-specific antibodies (DSA) increases the risk of graft failure. Although DSA characteristics, human leukocyte antigen class specificity, mean fluorescence intensity and immunoglobulin G subclasses, and their impact on the graft are quite well studied in solid organ transplants, very little information is known about their impact on vascularized composite allotransplantation (VCA). The aim of this review is to highlight recent publications regarding occurrence and effects of DSA, their follow-up and treatment in the field of VCA.

Recent findings The latest publications dealing with antibody-mediated rejection in VCA are mainly case presentations and reports embedded in reviews. The most important findings shown were the demonstration of the severe clinical impact of de-novo DSA and the urgent need of finding a therapeutic strategy for patients with acute antibody-mediated rejection. Suggested protocols for desensitization of possible candidates for reconstructive transplantation have been published, as these individuals are often highly sensitized and not appropriate patients for a standard surgical procedure because of their major tissue defects.

Summary The functional outcome of reconstructive transplantation has clearly exceeded the results achieved with conventional surgical techniques. The recipients’ immune response, particularly development of DSA and the long-term adherence, which is probably associated with the occurrence of chronic rejection, remain a challenge.

aNuffield Department of Surgical Sciences, Oxford Transplant Centre, Churchill Hospital, Oxford University, Oxford, UK

bCenter for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria

cParis Translational Research Center for Organ Transplantation, Paris, France

dTransplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Dr Annemarie Weissenbacher, MD, Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Churchill Hospital, Oxford OX3 7LE, UK. e-mail:

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