Novel Immunological Insights into Vascularized Composite Allotransplantation – From Bench to Bedside

Every year, ~200,000 amputations take place in the US due to trauma, oncological resection, or severe burns. In combination with a steep increase of severe facial trauma and loss of facial subunits (nose, ear, lip) over the past years, these numbers underpin the need for advanced reconstructive surgery. Vascularized composite allotransplantation (VCA) is considered the only surgical approach to restore form and function in patients with extensive and irreversible tissue loss. VCA surgery has demonstrated positive short- and long-term outcomes.

However, VCA surgery remains a low-volume high-cost procedure. Alloreactive rejection of the VCA transplant persists as a major barrier that hinders broader access to VCA surgery. Even under standard immunosuppression the majority of VCA recipients report acute rejection episodes within the first-year post-transplantation, with chronic rejection being the leading cause of graft failure.

Acute and chronic allograft rejection represent the central bottleneck in VCA. Standard immunosuppression has shown limited efficacy to mitigate rejection reaction in VCA recipients. Therefore, novel and innovative approaches are needed to provide patient-tailored care and effectively prevent and treat acute and chronic graft rejections.

We welcome the submission of Original Research, Review, Mini Review, and Perspective articles on themes including, but not limited to:

- Prevention and/or treatment of acute and/or chronic VCA graft rejection

- Screening VCA recipients for risk factors of graft rejection and identifying high-risk patients

- Targeting novel immunological pitfalls in VCA patients in preclinical models and clinical trials

- Optimizing perioperative patient management

- Improving the efficacy and side-effects of pre- and post-operative immunosuppression in VCA patients

- Investigating novel and innovative strategies to modulate the VCA recipient’s immune system and improve graft survival

- Assessing effective tools for diagnosing and grading acute and/or chronic VCA rejection

- Developing strategies to optimize VCA follow-up

- Discussing the potential impact of AI-supported tools in VCA research and surgery

Article types and fees

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Research Topic accepts the following article types, unless otherwise specified in the Research Topic description:

• Brief Research Report
• Case Report
• Classification
• Clinical Trial
• Editorial
• FAIR² Data
• General Commentary
• Hypothesis and Theory
• Methods
• Mini Review
• Opinion
• Original Research
• Perspective
• Review
• Systematic Review
• Technology and Code

Keywords: Vascularized composite allotransplantation, cellular therapies, targeted therapies, immunotherapies, immunotolerance induction, human trials, animal models

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.