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首页> 外文期刊>Transplant immunology >Successful transatlantic bilateral hand transplant in a young female highly sensitized to HLA class II antigens
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Successful transatlantic bilateral hand transplant in a young female highly sensitized to HLA class II antigens

机译：成功的跨大西洋双侧手移植在一个高度敏感到HLA II类抗原的年轻女性中

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Vascularized composite allografts may be more susceptible to rejection than other types of organ transplants, particularly in sensitized recipients. We describe a successful transatlantic bilateral hand transplant in a 40-year old woman who was highly sensitized to class II HLA antigens including HLA-DPB1 (UNet CPRA = 86%). Prior to transplantation, we selected an upper limb donor based on HLA class II matching and absence of donor specific antibodies, given evidence that class II mismatches are associated with acute cellular rejection in hand transplants. The patient was conditioned using five doses of thymoglobulin, and her immunosuppression included tacrolimus, rapamycin, mycophenolate, and prednisone. Post-transplant, the patient non-DSA anti-HLA antibody levels drastically increased, but only transiently and weak DSAs developed, which became undetectable by two months posttransplant. Following transplantation, periodic biopsies over 6 months indicated no evidence of rejection except for transient Banff grade 1 and one sample with grade 2 acute rejection. There was no evidence of rejection on her recent 1-year follow-up. The patient is currently healthy, has recovered protective sensibility, and is regaining excellent function. This case highlights the importance of pre-transplantation planning, donor selection/compatibility, and ethical considerations in the ultimate success of VCA.
机译：与其他类型的器官移植相比，带血管的复合同种异体移植物可能更容易发生排斥反应，尤其是在致敏受体中。我们描述了一例成功的跨大西洋双侧手移植，患者为一名40岁女性，对包括HLA-DPB1在内的II类HLA抗原高度敏感（UNet CPRA=86%）。移植前，我们根据HLA II类匹配和缺乏供者特异性抗体选择了上肢供者，因为有证据表明II类错配与手移植中的急性细胞排斥反应有关。患者接受了五剂胸腺球蛋白治疗，她的免疫抑制包括他克莫司、雷帕霉素、霉酚酸酯和强的松。移植后，患者的非DSA抗HLA抗体水平显著升高，但仅出现短暂的弱DSA，移植后两个月无法检测到。移植后，6个月以上的定期活检表明，除暂时性Banff 1级和一例2级急性排斥外，没有排斥反应的证据。在她最近一年的随访中，没有证据表明她被拒绝。患者目前身体健康，恢复了保护性敏感性，正在恢复良好的功能。本例强调了移植前计划、供者选择/相容性和伦理考虑对VCA最终成功的重要性。

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