The mission of the Vascularized Composite Allotransplantation (VCA) Research Laboratory is to become the laboratory of reference for scientific research in the field of reconstructive transplantation, where combined cutting edge basic and translational research provides the scientific foundation for clinical programs worldwide
What is VCA?
Vascularized Composite Allotransplantation (VCA), a branch of reconstructive transplantation, involves the transfer of a limb or body feature from one person to another. These procedures, such as hand or face transplantation, have become a clinical reality and valid treatment options for patients suffering from complex tissue injuries or defects. The functional outcomes of such treatment options are far superior to the gains afforded by any currently available prosthesis.
However, there are two primary challenges facing widespread implementation of this therapy: immunological rejection and the natural pace of nerve regeneration. To ward against the body’s rejection of the transplanted limb or tissue, patients are required to take a regimen of multiple immunosuppressive drugs over the course of their lifetime. As we learn from the field of solid organ transplantation, chronic use of these drugs predisposes the patient to higher rates of infections and cancer while it also does not fully protect the transplanted tissues in the long term.
Meanwhile, as the transplanted limb or tissue is healing, the nerves grow back at an average pace of one inch per month. Depending on the limb or tissue size, it can take months for patients to regain a sense of feeling. Consequently, the current implementation of VCA must address a delicate balance of risks and benefits.
World's First Total Penile and Scrotum Transplant | Johns Hopkins Medicine
On March 26, 2018 a team of nine plastic surgeons and two urological surgeons at Johns Hopkins Medicine performed the world’s first total penile and scrotum transplant. In a 14-hour surgery, the entire penis, scrotum (without testicles) and partial abdominal wall of a deceased donor was transplanted to a veteran wounded in Afghanistan. This animation illustrates the transplantation process.
The Vascularized Composite Allotransplantation (VCA) Research Lab is leading research aimed at warding against rejection and reducing the number of medications patients have to take for the rest of their lives. They’re testing a protocol that involves treating the patient with antibodies on the day of transplant, followed by a donor bone marrow infusion several days later. This protocol would allow patients to be treated with low doses of a single maintenance drug after being transplanted.
Getting to the Basics
With a focus on the disciplines of transplant immunology and immunoregulation, regenerative medicine, nerve research, and microsurgical education we work to overcome the barriers to successful reconstructive transplantation. Starting with obtaining a better understanding of the basic mechanisms of transplant rejection, our research also focuses on unraveling the unique immunological features of VCA. We believe that focusing on these areas of investigation will give us a unique perspective on novel strategies of immunoregulation that could either significantly reduce the side effects of maintenance therapies or completely remove the lifelong need for these drugs.
One of our major strengths is the profound expertise in microsurgery, which allows us to easily implement a vast array of animal models ranging from mouse and rat surgeries to complex interventions in large animals (e.g. miniature swine). An advantage that is not commonly available in most research laboratories. With this capability, we can promptly implement and complete projects in both the area of immunoregulation as well as nerve regeneration for improved functional outcome in VCA.
#TomorrowsDiscoveries: Survival Rate After a Transplant – Giorgio Raimondi, Ph.D.
Giorgio Raimondi, Ph.D., and his lab are developing new multi-disciplinary approaches to find out why our bodies naturally recognize transplanted tissue as dangerous and try to destroy it.
#TomorrowsDiscoveries: Reconstructive Transplantation – Gerald Brandacher, M.D.
Gerald Brandacher, M.D., and his team are developing strategies to minimize or avoid the need for immunosuppressive drugs.
A Team Approach
Nowadays, progress in science depends on collaboration among multiple disciplines. We are privileged to have established professional partnerships with world-class experts in material science and biomaterials, stem cell biology and regenerative medicine, oncology, cryopreservation, and mathematical modeling. Together, they provide unique perspectives that fuel original research projects in our lab, and push the boundaries of investigation.
A Dynamic Learning Environment
In this dynamic environment, we place an emphasis on fostering the scientific growth of our laboratory members. We provide a unique environment where fellows with either a medical or scientific background can work together on basic science and translational studies. These interactions provide tremendous opportunities for the formation of future leading academic surgeons and scientific investigators. We believe this is the key for a profound impact in our scientific community that will ultimately provide invaluable benefit to our patient population.
Exploring the Vanguard of Transplantation: Hand, Face and Urogenital