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REVIEW article

Front. Transplant.
Sec. Vascularized Composite Allotransplantation
Volume 3 - 2024 | doi: 10.3389/frtra.2024.1442006
This article is part of the Research Topic Women in Vascularized Composite Allotransplantation View all 4 articles

The Role of C4d and Donor Specific Antibodies in Face and Hand Transplantation -a Systematic Review

Provisionally accepted
Lioba Huelsboemer Lioba Huelsboemer 1*Jake Moscarelli Jake Moscarelli 1Alna Dony Alna Dony 2Sam Boroumand Sam Boroumand 1Alejandro Kochen Alejandro Kochen 1Leonard Knoedler Leonard Knoedler 3Catherine T. Yu Catherine T. Yu 1Sacha C. Hauc Sacha C. Hauc 1Viola A. Stögner Viola A. Stögner 1Richard N. Formica Richard N. Formica 1Christine Lian Christine Lian 4Georg F. Murphy Georg F. Murphy 4Bohdan Pomahac Bohdan Pomahac 1Martin Kauke-Navarro MD Martin Kauke-Navarro MD 1
  • 1 Yale University, New Haven, Connecticut, United States
  • 2 University of Leeds, Leeds, England, United Kingdom
  • 3 University of Regensburg, Regensburg, Bavaria, Germany
  • 4 Harvard University, Cambridge, Massachusetts, United States

The final, formatted version of the article will be published soon.

    To date, little is known about the mechanisms of rejection in vascularized composite allotransplantation, particularly for antibody mediated rejection. Additionally, no clear guidelines exist for the diagnosis and management of antibody-mediated rejection in vascularized composite allotransplantation. A systematic review of electronic databases (Embase and PubMed) was conducted to identify relevant studies that reported rejection episodes and surrogates of antibody-mediated rejectionevaluate the relationship of donor specific antibodies and C4d deposition in correlation with cellular rejection following hand and face transplantation reported by centers between 1998 and July 2023. We extracted data on serum donor specific antibodies at the time of biopsy proven rejection according to Banff classification and C4d staining of target tissues. Mann-Whitney U tests were performed to compare rejection grade between groups divided by status of C4d deposition and serum donor specific antibodies, and Fisher's Exact test was used to assess association between the two markers. This review adhered to PRISMA guidelines. A total of 26 patients (5 face, 21 hand) were identified and data on 90 acute rejection episodes with information on Banff grade, donor specific antibody status, and C4d deposition were available. Donor specific antibodies were found to be associated with higher rejection grade (p=0.005). C4d was not found to be associated with higher rejection grade (p=0.33). Finally, no significant association was found between concurrent status of the two markers (p=0.23). These findings suggest that the presence of donor specifc antibodies may be associated with higher grades of acute cellular rejection following hand and face transplantation. More consistent reporting on rejection episodes is needed in order to better understand antibody-mediated rejection in vascularized composite allotransplantation.

    Keywords: C4d, Donor specific antibody, Vascularized Composite Allotransplantation, VCA, reconstructive surgery, Antibody-mediated Rejection

    Received: 01 Jun 2024; Accepted: 11 Jul 2024.

    Copyright: © 2024 Huelsboemer, Moscarelli, Dony, Boroumand, Kochen, Knoedler, Yu, Hauc, Stögner, Formica, Lian, Murphy, Pomahac and Kauke-Navarro MD. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lioba Huelsboemer, Yale University, New Haven, 06520, Connecticut, United States

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