An important and often underinvestigated contributor to solid organ transplant rejection
is ischemia reperfusion injury. This pathophysiological response releases damaging
reactive oxygen species and cell stress signals that initiate inflammation, which
has a critical role in priming the immune system for allorecognition. In time, this
renders graft dysfunction and how this response is mediated in composite tissues remains
unknown. Current protocols are drawn from solid organ transplantation with little
scientific basis as to how this informs current hand transplantation practices. In
addition to preservation flush and allograft cooling, machine perfusion is placing
itself experimentally as a concept that could act to promote viability and increase
the critical ischemic window, which is especially beneficial at a time of limited
donors. With the increasing prevalence worldwide of hand transplantation, we review
the potential contribution of ischemia reperfusion injury to hand allograft rejection
including both current and experimental strategies.
Key words
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Article info
Publication history
Published online: October 18, 2017
Accepted:
September 19,
2017
Received:
February 20,
2017
Footnotes
K.R.A. is funded by the Engineering and Physical Sciences Research Council/Medical Research Council, British Society for Surgery of the Hand, and the Royal College of Surgeons of England. The rest of the authors declare that they have no relevant conflicts of interest.
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© 2017 by the American Society for Surgery of the Hand. All rights reserved.
