Postoperative Monitoring: Biomarkers and Alloimmune Responses and Their Relevance to Vascularized Composite Allotransplantation

Abstract

Vascularized composite allotransplantation (VCA) is an evolving area of transplantation. Postoperative monitoring and immunosuppression strategies draw experience from solid organ transplantation, but VCA provides unique challenges as grafts incorporate histologically heterogenous tissues with differing degrees of antigenicity. In addition, such procedures are often life-improving rather than life-saving; therefore, minimizing the risks of immunosuppression is an important clinical priority. To this end, the identification of biomarkers to monitor the health of the transplanted tissues, assess alloimmune responses under the effects of immunosuppression, and identify episodes of rejection remain key goals. In this review we look at the general considerations of alloimmune monitoring, promising biomarkers in transplantation research, and their potential application to VCA.