Unraveling Chronic Rejection in Vascularized Composite Allotransplantation: Clinical Manifestations, Mechanisms, and Future Directions

Introduction

Vascularized composite allotransplantation (VCA) has revolutionized reconstructive surgery by enabling the transplantation of complex tissues including skin, muscle, bone, and nerves. Despite successes, long-term graft survival remains challenged by chronic rejection (CR), which emerges as a predominant cause of late graft failure. Unlike traditional solid organ transplants, VCAs involve multiple tissue targets, leading to diverse CR types with unique clinical and pathological features. Understanding these manifestations, underlying mechanisms, and therapeutic avenues is critical to improve outcomes.

Clinical Manifestations of Chronic Rejection in VCA