Vascularized composite allotransplantation (VCA) has emerged as a well-established reconstructive method for treating tissue defects. Worldwide, an increasing number of hand and upper extremity VCAs have been successfully performed, demonstrating short- to medium-term functional outcomes. Acute rejection is almost invariably seen in VCA, with a rate approximately six times higher than in solid organ transplants.

Optimal immunosuppression is key to maintaining VCA graft survival. To date, systemic administration of single or multiple immunosuppressive drugs such as CNI and tacrolimus (TAC) in combination with perioperative induction therapy is still the standard therapy to prevent graft rejection. However, this approach has a wide range of well-known side effects such as complications, nephrotoxicity and opportunistic infections. Targeted and controlled drug delivery systems for immunosuppression represent a paradigm shift in the management of immune-related disorders, offering distinct advantages over systemic immunosuppression. This research topic aims to delve into recent findings and innovations in localized therapy for allograft rejection in VCA, seeking input from both experts and new perspectives. We aim to gather more information about the advantages and limitations of different strategies, questioning their effectiveness.

We welcome a variety of articles (from original research to case studies and opinion pieces) that address, but are not limited to, the following topics:

1. Systemic versus local therapy: impact on transplant outcomes, advantages and disadvantages.

2. Immunological challenges: Exploration of host immune responses in both approaches.

3. Innovative techniques: drug delivery systems that allow local treatment.

4. Ethical implications: consideration of the ethical dilemmas surrounding biomaterials and how they can be addressed.

5. Technological Innovations: Discussion of technological breakthroughs that could influence the future of local therapy.

6. Long-term consequences: comparative review of the long-term effects of transplantation in both models, considering both medical and quality-of-life outcomes.

7. Regulatory standards and policies: Assessment of current international transplant regulations with respect to these approaches.

By encouraging dialogue between diverse perspectives, we hope to improve our understanding and shed light on next steps in research and application.

Key words: Transplantation, VCA, Allograft, Rejection, Local therapy

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

Vascularized composite allotransplantation (VCA) has emerged as a well-established reconstructive method for treating tissue defects. Worldwide, an increasing number of hand and upper extremity VCAs have been successfully performed, demonstrating functional results in the short to medium term. Acute rejection is almost invariably seen in VCA, with a rate approximately six times higher than in solid organ transplants.

Optimal immunosuppression is key to maintaining VCA graft survival. To date, systemic administration of single or multiple immunosuppressive drugs such as CNI and tacrolimus (TAC) in combination with perioperative induction therapy is still the standard therapy to prevent graft rejection. However, this approach has a wide range of well-known side effects such as complications, nephrotoxicity and opportunistic infections. Targeted and controlled drug delivery systems for immunosuppression represent a paradigm shift in the management of immune-related disorders, offering distinct advantages over systemic immunosuppression. This research topic aims to delve into recent findings and innovations in localized therapy for allograft rejection in VCA, seeking input from both experts and new perspectives. We aim to gather more information about the advantages and limitations of different strategies, questioning their effectiveness.

We welcome a variety of articles (from original research to case studies and opinion pieces) that address, but are not limited to, the following topics:

1. Systemic versus local therapy: impact on transplant outcomes, advantages and disadvantages.

2. Immunological challenges: Exploration of host immune responses in both approaches.

3. Innovative techniques: drug delivery systems that allow local treatment.

4. Ethical implications: consideration of the ethical dilemmas surrounding biomaterials and how they can be addressed.

5. Technological Innovations: Discussion of technological breakthroughs that could influence the future of local therapy.

6. Long-term consequences: comparative review of the long-term effects of transplantation in both models, considering both medical and quality-of-life outcomes.

7. Regulatory standards and policies: Assessment of current international transplant regulations with respect to these approaches.

By encouraging dialogue between diverse perspectives, we hope to improve our understanding and shed light on next steps in research and application.

Key words: Transplantation, VCA, Allograft, Rejection, Local therapy

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