Reconstructive transplantation, also referred to as vascularized composite allotransplantation (VCA), has rapidly emerged as a viable approach to repairing complex tissue defects. Over the past 20 years, major advances have been made in the field of VCA allowing for successful transplantation of over 150 hand/forearm/arm, larynx, trachea, abdominal wall, vascularized knee, and facial transplants with encouraging outcomes. These innovations have currently outpaced the scientific communityâs ability to fully address certain immunological and clinical challenges. The literature on ischemia-reperfusion injury (IRI) in VCA is limited and mechanistic questions remain. Specifically, the role IRI may play in acute rejection, the progression towards chronic rejection, or immune regulation and tolerance induction has only been partially or indirectly addressed. Hence, much of what we understand regarding IRI in VCA is extrapolated from research in solid organ transplantation.
The literature in SOT has clearly demonstrated that IRI is a potent activator of the immune system and subsequently leads to poor functional outcomes. IRI poses a unique challenge for the transplant surgeon, as some period of ischemia is unavoidable given the nature of the procedure. Ischemia, induced by donor organ procurement, cold preservation, and implantation, is one of several risk factors shown to contribute to both acute and chronic rejection
Last date updated on July, 2014