Hand and Face Allotransplantation
Conditions
Keywords
Composite tissue allograft, operational tolerance, skin rejection, Hand and Face allotransplantation
Brief summary
Composite tissue allotransplants (CTA) involve transplantation of various tissues including vessels, nerves, skin, bones, and immune cells and entail a significant antigenic load. The large majority of recipients have been maintained on immunosuppression therapy similar to that used in solid organ transplantation that is associated with the complications usually reported in solid organ transplantation. The question whether risks associated with indefinite immunosuppressive are justified for a non-lifesaving procedure still remains unanswered. At present no CTA recipient proved to be spontaneously tolerant with any immunosuppressive protocol; indeed, until now all recipients who discontinued the immunosuppressive therapy rejected their graft. On the other hand CTA recipients showed a low incidence of chronic rejection despite the high incidence of acute rejection episodes. For all these reasons it should be of great interest to minimize the immunosuppression in CTA patients knowing their immunologic risk. The main outcome of this study is to search for the signature of tolerance in recipients of hand or face allotransplantation testing biomarkers previously identified in operational tolerant kidney transplant recipients. These markers have been developed studying tolerant kidney recipients and they were already tested in five bilateral hand transplantations and one face transplantation. The present study will include hand and face allograft recipients transplanted at least one year in several European institutions (Innsbruck, Lyon, Monza, Valencia): 11 bilateral hand transplantations, 4 single hand transplantations and 3 face transplantations. All the patients will undergo B cell phenotyping, TCR repertoire, molecular signature from operational tolerance and a skin biopsy with immunohistochemical staining of the specimens in order to show signs of acute or chronic rejection. The results could provide a valid tool to detect operationally tolerant recipients as well as recipients prone to develop chronic rejection.
Interventions
PROCEDUREBlood sample, biopsy
Sponsors
ISTITUTO ITALIANO CHIRURGIA DELLA MANO, Italy
medizinische universität innsbruck, Austria
Hospital Clínico Universitario de Valencia
Hospices Civils de Lyon
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient with Hand (unilateral/bilateral) or face allotransplantation for at least one year * Patient without clinical sign of acute rejection at inclusion * Patient who signed the informed protocol consent * Patient older than 18 years old * Patient covered by an health insurance * Patient without legal protection
Exclusion criteria
* Patient with Hand or face allotransplantation for less than one year * Patient with clinical sign of acute rejection at inclusion * Unsigned protocol consent * Patient under the age of 18 years old
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Biomarkers of molecular signature from operational tolerance and/or chronic rejection research | 1 day | B cell phenotyping, TCR repertoire, molecular signature from operational tolerance |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pathological characteristics of skin acute/chronic rejection on skin biopsy | 1 day | skin biopsy with immunohistochemical staining of the specimens in order to show signs of acute or chronic rejection. We will try to correlate the signature of tolerance with the absence of chronic rejection symptoms, both clinically and in skin protocol biopsies. |
| Phenotype of skin T lymphocyte in cutaneous biopsies | 1 day | — |
Countries
France
Outcome results
None listed