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51


Facial Transplantation: Principles and Evolving Concepts

Kantar, Rami S; Alfonso, Allyson R; Diep, Gustave K; Berman, Zoe P; Rifkin, William J; Diaz-Siso, J Rodrigo; Sosin, Michael; Gelb, Bruce E; Ceradini, Daniel J; Rodriguez, Eduardo D
LEARNING OBJECTIVES/OBJECTIVE:After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two decades. 2. Discuss indications and contraindications for facial transplantation, and donor and recipient selection criteria and considerations. 3. Discuss logistical, immunologic, and cost considerations in facial transplantation, in addition to emerging technologies used. 4. Understand surgical approaches and anatomical and technical nuances of the procedure. 5. Describe aesthetic, functional, and psychosocial outcomes of facial transplantation reported to date. SUMMARY/CONCLUSIONS:This CME article highlights principles and evolving concepts in facial transplantation. The field has witnessed significant advances over the past two decades, with more than 40 face transplants reported to date. The procedure now occupies the highest rung on the reconstructive ladder for patients with extensive facial disfigurement who are not amenable to autologous reconstructive approaches, in pursuit of optimal functional and aesthetic outcomes. Indications, contraindications, and donor and recipient considerations for the procedure are discussed. The authors also review logistical, immunologic, and cost considerations of facial transplantation. Surgical approaches to allograft procurement and transplantation, in addition to technical and anatomical nuances of the procedure, are provided. Finally, the authors review aesthetic, functional, and psychosocial outcomes that have been reported to date.
PMID: 34019516
ISSN: 1529-4242
CID: 4877732

Vascularized Composite Allotransplantation and Immunobiology: The Next Frontier

Jacoby, Adam; Cohen, Oriana; Gelb, Bruce E; Ceradini, Daniel J; Rodriguez, Eduardo D
PMID: 34019530
ISSN: 1529-4242
CID: 4877742

Pancreas Transplantation from Hepatitis C Viremic Donors to Uninfected Recipients

Lonze, Bonnie E; Baptiste, Gillian; Ali, Nicole M; Dagher, Nabil N; Gelb, Bruce E; Mattoo, Aprajita; Soomro, Irfana; Tatapudi, Vashista S; Montgomery, Robert A; Stewart, Zoe A
Despite utilization of hepatitis C viremic organs for hepatitis C naïve recipients (HCV D+/R-) in other solid organ transplants, HCV viremic pancreata remain an unexplored source of donor organs. This study reports the first series of HCV D+/R- pancreas transplants. HCV D+/R- had shorter wait list times compared to HCV D-/R-, waiting a mean of 16 days from listing for HCV positive organs. HCV D+/R- had a lower match allocation sequence than HCV D-/R-, and this correlated to receipt of organs with a lower Pancreas Donor Risk Index (PDRI) score. All HCV D+R- had excellent graft function with a mean follow up of 438 days and had undetectable HCV RNA levels by a mean of 23 days after initiation of HCV-directed therapy. The rates of infectious complications, re-operation, readmission, rejection, and length of stay were not impacted by donor HCV status. A national review of potential ideal pancreas donors found that 37% of ideal HCV negative pancreas allografts were transplanted, compared to only 5% of ideal HCV positive pancreas allografts. The results of the current study demonstrate the safety of accepting HCV positive pancreata for HCV naïve recipients and advocates for increased utilization of ideal HCV positive pancreas allografts.
PMID: 33346951
ISSN: 1600-6143
CID: 4726692

Measles Outbreak Risk Assessment for Transplant Candidates and Recipients

Kreiger-Benson, Elana; Gelb, Bruce; Neumann, Henry J; Hochman, Sarah; Lighter, Jennifer; Mehta, Sapna A
Solid organ transplant (SOT) candidates and recipients are at risk of significant morbidity and mortality from infection, including those circulating in the community from unexpected outbreaks. In late 2018-summer of 2019, a measles outbreak occurred in the New York City area, with a total of 649 cases reported. We developed a systematic three-part approach to address measles risk in our adult SOT program through: 1) identification of non-immune adults living in outbreak ZIP codes, 2) education focused on risk reduction for patients from outbreak ZIP codes and 3) risk reduction for non-immune patients. All waitlisted or previously transplanted patients residing in outbreak areas received a measles patient education handout. The electronic medical record of patients born in or after 1957 was reviewed for serologic evidence of measles immunity. Measles immunity testing was performed in patients without documentation of immunity. Patients who tested non-immune were offered MMR vaccination or intravenous immunoglobulin depending on their transplant phase and risk profile. Thus, we demonstrate successful implementation of a systematic risk assessment during a large measles outbreak to identify and protect at-risk SOT patients. As vaccine hesitancy persists, our strategies may be increasingly relevant to transplant centers and those caring for immunocompromised patients.
PMID: 32808470
ISSN: 1600-6143
CID: 4583752

Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

Caplin, Nina J; Zhadanova, Olga; Tandon, Manish; Thompson, Nathan; Patel, Dhwanil; Soomro, Qandeel; Ranjeeta, Fnu; Joseph, Leian; Scherer, Jennifer; Joshi, Shivam; Dyal, Betty; Chawla, Harminder; Iyer, Sitalakshmi; Bails, Douglas; Benstein, Judith; Goldfarb, David S; Gelb, Bruce; Amerling, Richard; Charytan, David M
ORIGINAL:0015108
ISSN: n/a
CID: 4874982

Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

Caplin, Nina J; Zhadanova, Olga; Tandon, Manish; Thompson, Nathan; Patel, Dhwanil; Soomro, Qandeel; Ranjeeta, Fnu; Joseph, Leian; Scherer, Jennifer; Joshi, Shivam; Dyal, Betty; Chawla, Harminder; Iyer, Sitalakshmi; Bails, Douglas; Benstein, Judith; Goldfarb, David S; Gelb, Bruce; Amerling, Richard; Charytan, David M
ORIGINAL:0015107
ISSN: 2641-7650
CID: 4874972

A Comparison of Immunosuppression Regimens in Hand, Face, and Kidney Transplantation

Rifkin, William J; Manjunath, Amit K; Kantar, Rami S; Jacoby, Adam; Kimberly, Laura L; Gelb, Bruce E; Diaz-Siso, J Rodrigo; Rodriguez, Eduardo D
BACKGROUND:Authors have speculated that vascularized composite allotransplantation (VCA) recipients may require greater maintenance immunosuppression than solid organ transplant (SOT) recipients due to the higher antigenicity of skin. However, detailed comparisons of VCA and SOT immunosuppression regimens have been limited. METHODS:Hand and face VCA recipient immunosuppression data were collected through a systematic literature review. Kidney recipient data were obtained through a retrospective chart review of the authors' institution. Prednisone and mycophenolate mofetil (MMF) doses were compared between VCA and kidney recipients at predefined follow-up intervals (<1, 1-5, and >5 y). Tacrolimus target trough levels (TTTL) were compared at follow-up intervals of 1-5 and >5 y, and stratified into our institution's kidney transplant risk-based target ranges (4-6 ng/mL, 6-8 ng/mL) or higher (>8 ng/mL). RESULTS:Immunosuppression data were available for 57 VCA and 98 kidney recipients. There were no significant differences in prednisone doses between groups at all follow-up intervals. VCA recipient mean MMF dose was significantly greater at <1-y (1.71 ± 0.58 versus 1.16 ± 0.55 gm/d; P = 0.01). For VCA recipients, there was a significant difference (P = 0.02) in TTTL distribution over the three predefined therapeutic ranges (4-6 ng/mL, 6-8 ng/mL, and >8 ng/mL) between 1 and 5 y (24.0%, 20.0%, 56.0%, respectively) and >5 y (28.6%, 42.9%, 28.6%). CONCLUSIONS:At longer follow-up, VCA and kidney recipients receive comparable MMF/prednisone doses, and most VCA recipients are treated with TTTL similar to kidney recipients. Further research may improve our understanding of VCA's complex risk/benefit ratio, and enhance informed consent.
PMID: 32977237
ISSN: 1095-8673
CID: 4609112

A case of facial composite tissue allograft rejection [Case Report]

Yan, Di; Stokar, Evan; Jacoby, Adam; Gelb, Bruce E; Rodriguez, Eduardo D; Meehan, Shane A
PMCID:7452299
PMID: 32875035
ISSN: 2352-5126
CID: 4615392

Vascularized Composite Allotransplantation 2.0: The Future Is Now

Ramly, Elie P; Berman, Zoe P; Diep, Gustave K; Alfonso, Allyson R; Kimberly, Laura L; Gelb, Bruce E; Rodriguez, Eduardo D
PMID: 32842130
ISSN: 1529-4242
CID: 4614452

Lung-derived HMGB1 is detrimental for vascular remodeling of metabolically imbalanced arterial macrophages

Boytard, Ludovic; Hadi, Tarik; Silvestro, Michele; Qu, Hengdong; Kumpfbeck, Andrew; Sleiman, Rayan; Fils, Kissinger Hyppolite; Alebrahim, Dornazsadat; Boccalatte, Francesco; Kugler, Matthias; Corsica, Annanina; Gelb, Bruce E; Jacobowitz, Glenn; Miller, George; Bellini, Chiara; Oakes, Jessica; Silvestre, Jean-Sébastien; Zangi, Lior; Ramkhelawon, Bhama
Pulmonary disease increases the risk of developing abdominal aortic aneurysms (AAA). However, the mechanism underlying the pathological dialogue between the lungs and aorta is undefined. Here, we find that inflicting acute lung injury (ALI) to mice doubles their incidence of AAA and accelerates macrophage-driven proteolytic damage of the aortic wall. ALI-induced HMGB1 leaks and is captured by arterial macrophages thereby altering their mitochondrial metabolism through RIPK3. RIPK3 promotes mitochondrial fission leading to elevated oxidative stress via DRP1. This triggers MMP12 to lyse arterial matrix, thereby stimulating AAA. Administration of recombinant HMGB1 to WT, but not Ripk3-/- mice, recapitulates ALI-induced proteolytic collapse of arterial architecture. Deletion of RIPK3 in myeloid cells, DRP1 or MMP12 suppression in ALI-inflicted mice repress arterial stress and brake MMP12 release by transmural macrophages thereby maintaining a strengthened arterial framework refractory to AAA. Our results establish an inter-organ circuitry that alerts arterial macrophages to regulate vascular remodeling.
PMID: 32855420
ISSN: 2041-1723
CID: 4575922