{"id":"https://openalex.org/W7204253441","doi":"https://doi.org/10.1186/s44452-026-00035-7","title":"Immunosuppressive modulation after vascularized composite allotransplantation: current practice and future directions","display_name":"Immunosuppressive modulation after vascularized composite allotransplantation: current practice and future directions","publication_year":2026,"publication_date":"2026-08-26","ids":{"openalex":"https://openalex.org/W7204253441","doi":"https://doi.org/10.1186/s44452-026-00035-7"},"language":"en","primary_location":{"id":"doi:10.1186/s44452-026-00035-7","doi":"https://doi.org/10.1186/s44452-026-00035-7","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s44452-026-00035-7","pdf_url":"https://link.springer.com/content/pdf/10.1186/s44452-026-00035-7.pdf","source":{"id":"https://openalex.org/S5407051657","display_name":"BMC Plastic and Reconstructive Surgery","issn_l":"3059-3697","issn":["3059-3697"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Plastic and Reconstructive Surgery","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://link.springer.com/content/pdf/10.1186/s44452-026-00035-7.pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5093747401","display_name":"Emanuella Brito","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1316902750","display_name":"Cleveland Clinic","ror":"https://ror.org/03xjacd83","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1316902750"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Emanuella M. Brito","raw_affiliation_strings":["Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Ave, A-60, Cleveland, OH, 44195, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Ave, A-60, Cleveland, OH, 44195, USA","institution_ids":["https://openalex.org/I1316902750"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5148335413","display_name":"James O. Gaston","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1316902750","display_name":"Cleveland Clinic","ror":"https://ror.org/03xjacd83","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1316902750"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"James O. Gaston","raw_affiliation_strings":["Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Ave, A-60, Cleveland, OH, 44195, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Ave, A-60, Cleveland, OH, 44195, USA","institution_ids":["https://openalex.org/I1316902750"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5121969673","display_name":"Ahmed M. Hashem","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I1316902750","display_name":"Cleveland Clinic","ror":"https://ror.org/03xjacd83","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1316902750"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Ahmed M. Hashem","raw_affiliation_strings":["Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Ave, A-60, Cleveland, OH, 44195, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Plastic Surgery, Cleveland Clinic, 9500 Euclid Ave, A-60, Cleveland, OH, 44195, USA","institution_ids":["https://openalex.org/I1316902750"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5121969673"],"corresponding_institution_ids":["https://openalex.org/I1316902750"],"apc_list":{"value":1990,"currency":"USD","value_usd":1990},"apc_paid":{"value":1990,"currency":"USD","value_usd":1990},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.65776987,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"2","issue":"1","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12900","display_name":"Organ and Tissue Transplantation Research","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2747","display_name":"Transplantation"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12900","display_name":"Organ and Tissue Transplantation Research","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2747","display_name":"Transplantation"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11189","display_name":"Transplantation: Methods and Outcomes","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10599","display_name":"Reconstructive Surgery and Microvascular Techniques","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2746","display_name":"Surgery"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/vascularized-composite-allotransplantation","display_name":"vascularized composite allotransplantation","score":1.0},{"id":"https://openalex.org/keywords/immunosuppression","display_name":"immunosuppression","score":0.9470000267028809},{"id":"https://openalex.org/keywords/graft-rejection","display_name":"graft rejection","score":0.6769999861717224},{"id":"https://openalex.org/keywords/induction-immunosuppression","display_name":"induction immunosuppression","score":0.7480000257492065},{"id":"https://openalex.org/keywords/maintenance-immunosuppression","display_name":"maintenance immunosuppression","score":0.9750000238418579},{"id":"https://openalex.org/keywords/hand-transplantation","display_name":"hand transplantation","score":0.5690000057220459},{"id":"https://openalex.org/keywords/facial-transplantation","display_name":"face transplantation","score":0.9559999704360962},{"id":"https://openalex.org/keywords/uterus-transplantation","display_name":"uterus transplantation","score":0.875},{"id":"https://openalex.org/keywords/abdominal-wall-reconstruction","display_name":"abdominal wall reconstruction","score":0.8759999871253967},{"id":"https://openalex.org/keywords/laryngeal-transplantation","display_name":"laryngeal transplantation","score":0.9559999704360962},{"id":"https://openalex.org/keywords/costimulation-blockade","display_name":"costimulation blockade","score":0.8629999756813049},{"id":"https://openalex.org/keywords/regulatory-t-cell-therapy","display_name":"regulatory T cell therapy","score":0.9990000128746033},{"id":"https://openalex.org/keywords/tolerance-induction","display_name":"tolerance induction","score":0.5419999957084656}],"concepts":[{"id":"https://openalex.org/C148043351","wikidata":"https://www.wikidata.org/wiki/Q4456944","display_name":"Current (fluid)","level":2,"score":0.5203999876976013},{"id":"https://openalex.org/C123079801","wikidata":"https://www.wikidata.org/wiki/Q750240","display_name":"Modulation (music)","level":2,"score":0.4740000069141388},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.43959999084472656},{"id":"https://openalex.org/C104779481","wikidata":"https://www.wikidata.org/wiki/Q50707","display_name":"Composite number","level":2,"score":0.42719998955726624},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.4154999852180481},{"id":"https://openalex.org/C24326235","wikidata":"https://www.wikidata.org/wiki/Q126095","display_name":"Electronic engineering","level":1,"score":0.357699990272522},{"id":"https://openalex.org/C136229726","wikidata":"https://www.wikidata.org/wiki/Q327092","display_name":"Biomedical engineering","level":1,"score":0.32030001282691956},{"id":"https://openalex.org/C2779974597","wikidata":"https://www.wikidata.org/wiki/Q28448986","display_name":"Clinical Practice","level":2,"score":0.3174999952316284},{"id":"https://openalex.org/C127413603","wikidata":"https://www.wikidata.org/wiki/Q11023","display_name":"Engineering","level":0,"score":0.31189998984336853},{"id":"https://openalex.org/C2991678113","wikidata":"https://www.wikidata.org/wiki/Q1427096","display_name":"Immune modulation","level":3,"score":0.2741999924182892},{"id":"https://openalex.org/C11930861","wikidata":"https://www.wikidata.org/wiki/Q181417","display_name":"Frequency modulation","level":3,"score":0.27160000801086426},{"id":"https://openalex.org/C24890656","wikidata":"https://www.wikidata.org/wiki/Q82811","display_name":"Acoustics","level":1,"score":0.2671000063419342},{"id":"https://openalex.org/C119599485","wikidata":"https://www.wikidata.org/wiki/Q43035","display_name":"Electrical engineering","level":1,"score":0.2606000006198883},{"id":"https://openalex.org/C92746544","wikidata":"https://www.wikidata.org/wiki/Q585184","display_name":"Pulse-width modulation","level":3,"score":0.25920000672340393},{"id":"https://openalex.org/C192562407","wikidata":"https://www.wikidata.org/wiki/Q228736","display_name":"Materials science","level":0,"score":0.25220000743865967}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1186/s44452-026-00035-7","doi":"https://doi.org/10.1186/s44452-026-00035-7","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s44452-026-00035-7","pdf_url":"https://link.springer.com/content/pdf/10.1186/s44452-026-00035-7.pdf","source":{"id":"https://openalex.org/S5407051657","display_name":"BMC Plastic and Reconstructive Surgery","issn_l":"3059-3697","issn":["3059-3697"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Plastic and Reconstructive Surgery","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.1186/s44452-026-00035-7","doi":"https://doi.org/10.1186/s44452-026-00035-7","is_oa":true,"landing_page_url":"https://doi.org/10.1186/s44452-026-00035-7","pdf_url":"https://link.springer.com/content/pdf/10.1186/s44452-026-00035-7.pdf","source":{"id":"https://openalex.org/S5407051657","display_name":"BMC Plastic and Reconstructive Surgery","issn_l":"3059-3697","issn":["3059-3697"],"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-nc-nd","license_id":"https://openalex.org/licenses/cc-by-nc-nd","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"BMC Plastic and Reconstructive Surgery","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":0.9940000176429749,"display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"id":"https://metadata.un.org/sdg/2","score":0.667667806148529,"display_name":"Zero hunger"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7204253441.pdf","grobid_xml":"https://content.openalex.org/works/W7204253441.grobid-xml"},"referenced_works_count":82,"referenced_works":["https://openalex.org/W264204338","https://openalex.org/W1540600778","https://openalex.org/W1545460581","https://openalex.org/W1948508886","https://openalex.org/W1970689376","https://openalex.org/W1971278669","https://openalex.org/W1987316597","https://openalex.org/W2006373373","https://openalex.org/W2006428846","https://openalex.org/W2075288731","https://openalex.org/W2076033327","https://openalex.org/W2077923788","https://openalex.org/W2084795750","https://openalex.org/W2088761087","https://openalex.org/W2098874338","https://openalex.org/W2147050732","https://openalex.org/W2153313364","https://openalex.org/W2155144605","https://openalex.org/W2160482627","https://openalex.org/W2279260190","https://openalex.org/W2294227801","https://openalex.org/W2313200120","https://openalex.org/W2329558878","https://openalex.org/W2341703153","https://openalex.org/W2352778559","https://openalex.org/W2411278515","https://openalex.org/W2585752240","https://openalex.org/W2786571997","https://openalex.org/W2802585469","https://openalex.org/W2885927385","https://openalex.org/W2886183777","https://openalex.org/W2897822162","https://openalex.org/W2903673787","https://openalex.org/W2910905098","https://openalex.org/W2991683950","https://openalex.org/W3006475167","https://openalex.org/W3007372046","https://openalex.org/W3013547826","https://openalex.org/W3085284605","https://openalex.org/W3094840760","https://openalex.org/W3096978771","https://openalex.org/W3109622541","https://openalex.org/W3110147759","https://openalex.org/W3124005009","https://openalex.org/W3155062516","https://openalex.org/W3175516090","https://openalex.org/W3196075249","https://openalex.org/W4206928235","https://openalex.org/W4220721689","https://openalex.org/W4289333458","https://openalex.org/W4297024822","https://openalex.org/W4303958888","https://openalex.org/W4310351750","https://openalex.org/W4319773258","https://openalex.org/W4321071979","https://openalex.org/W4362723214","https://openalex.org/W4367668266","https://openalex.org/W4376875476","https://openalex.org/W4380577441","https://openalex.org/W4383652647","https://openalex.org/W4389943082","https://openalex.org/W4391036641","https://openalex.org/W4391293773","https://openalex.org/W4391597382","https://openalex.org/W4392570998","https://openalex.org/W4394674597","https://openalex.org/W4395447220","https://openalex.org/W4398221932","https://openalex.org/W4399785468","https://openalex.org/W4402636378","https://openalex.org/W4406613825","https://openalex.org/W4407101199","https://openalex.org/W4408301592","https://openalex.org/W4411947791","https://openalex.org/W4412083102","https://openalex.org/W4413349976","https://openalex.org/W4416771158","https://openalex.org/W4417449871","https://openalex.org/W7127052396","https://openalex.org/W7129423175","https://openalex.org/W7134132227","https://openalex.org/W7153253068"],"related_works":[],"abstract_inverted_index":{"Vascularized":[0],"composite":[1,47],"allotransplantation":[2],"(VCA)":[3],"has":[4],"expanded":[5],"the":[6,43,72,86,126,155],"reconstructive":[7,73],"options":[8],"for":[9,159],"patients":[10],"with":[11,143],"devastating":[12],"tissue":[13],"loss,":[14],"yet":[15],"its":[16],"dependence":[17],"on":[18],"lifelong,":[19],"non-specific":[20],"systemic":[21,131],"immunosuppression":[22,99,132],"remains":[23],"a":[24,134],"defining":[25],"constraint.":[26],"Because":[27],"current":[28],"protocols":[29],"are":[30,38],"largely":[31],"extrapolated":[32],"from":[33],"solid":[34],"organ":[35],"transplantation,":[36,84],"they":[37],"not":[39],"well":[40],"matched":[41],"to":[42],"immunologic":[44,107],"heterogeneity":[45],"of":[46,129],"grafts,":[48],"in":[49,100],"which":[50],"skin,":[51],"mucosa,":[52],"vasculature,":[53],"and":[54,75,77,85,97,115,118,140,149],"other":[55],"tissues":[56],"each":[57],"contribute":[58],"distinct":[59],"rejection":[60],"mechanisms.":[61],"Although":[62],"VCA":[63],"demands":[64],"multi-specialty":[65],"collaboration,":[66],"plastic":[67],"surgeons":[68],"remain":[69],"central":[70],"throughout":[71],"process":[74],"beyond,":[76],"must":[78],"therefore":[79],"understand":[80],"how":[81,103],"surgical":[82],"reconstruction,":[83],"immune":[87],"response":[88],"interact.":[89],"This":[90],"narrative":[91],"review":[92],"summarizes":[93],"conventional":[94,130],"induction,":[95],"maintenance,":[96],"rejection-directed":[98],"VCA;":[101],"examines":[102],"graft":[104,152],"composition":[105],"shapes":[106],"risk":[108],"across":[109],"hand,":[110],"face,":[111],"uterus,":[112],"abdominal":[113],"wall,":[114],"laryngeal":[116],"transplantation;":[117],"evaluates":[119],"emerging":[120],"immunomodulatory":[121],"strategies.":[122],"We":[123],"conclude":[124],"that":[125],"inherent":[127],"limitations":[128],"necessitate":[133],"paradigm":[135],"shift":[136],"towards":[137],"phenotype-guided,":[138],"regional,":[139],"tolerance-inducing":[141],"strategies,":[142],"costimulation":[144],"blockade,":[145],"regulatory":[146],"T-cell":[147],"therapy,":[148],"ex":[150],"vivo":[151],"engineering":[153],"representing":[154],"most":[156],"promising":[157],"avenues":[158],"future":[160],"clinical":[161],"translation.":[162]},"counts_by_year":[],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2026-08-27T00:00:00"}
