TY - JOUR A2 - Brandacher, Gerald AU - Schnider, Jonas T. AU - Weinstock, Matthias AU - Plock, Jan A. AU - Solari, Mario G. AU - Venkataramanan, Raman AU - Zheng, Xin Xiao AU - Gorantla, Vijay S. PY - 2013 DA - 2013/02/13 TI - Site-Specific Immunosuppression in Vascularized Composite Allotransplantation: Prospects and Potential SP - 495212 VL - 2013 AB - Skin is the most immunogenic component of a vascularized composite allograft (VCA) and is the primary trigger and target of rejection. The skin is directly accessible for visual monitoring of acute rejection (AR) and for directed biopsy, timely therapeutic intervention, and management of AR. Logically, antirejection drugs, biologics, or other agents delivered locally to the VCA may reduce the need for systemic immunosuppression with its adverse effects. Topical FK 506 (tacrolimus) and steroids have been used in clinical VCA as an adjunct to systemic therapy with unclear beneficial effects. However, there are no commercially available topical formulations for other widely used systemic immunosuppressive drugs such as mycophenolic acid, sirolimus, and everolimus. Investigating the site-specific therapeutic effects and efficacy of systemically active agents may enable optimizing the dosing, frequency, and duration of overall immunosuppression in VCA with minimization or elimination of long-term drug-related toxicity. SN - 2314-8861 UR - https://doi.org/10.1155/2013/495212 DO - 10.1155/2013/495212 JF - Clinical and Developmental Immunology PB - Hindawi Publishing Corporation KW - ER -