An integrated view of immune monitoring in vascularized composite allotransplantation

作者：Sicard Antoine; Kanitakis Jean; Dubois Valerie; Petruzzo Palmina; Badet Lionel; Thaunat Olivier; Morelon Emmanuel^*

来源：Current Opinion in Organ Transplantation, 2016, 21(5): 516-522.

DOI：10.1097/MOT.0000000000000354

• donor-specific antibodies
• immune monitoring
• skin biopsy
• vascularized composite allotransplantation

Purpose of reviewVascularized 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.Recent findingsBecause 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.SummaryStrategies 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.

• 出版日期2016-10