Vascularized composite allotransplantation (VCA) refers to the transplantation of multiple tissues, such as skin, muscle, tendon, nerve, and/or bone, as a functional unit (e.g. a hand, an abdominal wall). Several recent advances in clinical organ transplant immunosuppression and experimental VCA have now made it feasible to consider clinical VCA for functional restoration in patients with the loss of one or both hands or large tissue defects that may not be reconstructed with autologous tissue. My research facilitates the translation of VCA from the bench to the bedside.
Our group has established preclinical models to understand VCA rejection in different tissues and to use that insight to minimize immunosuppression in VCA recipients who participate in clinical trials. We also organized the first public international consensus discussions conference in VCA at the Ninth Banff Conference on Allograft Pathology in Spain in 2007 resulting in the Banff VCA 2007 classification for skin allograft pathology. Additionally, we established a VCA Consortium to enable the comprehensive analysis of samples from patients in VCA clinical trials around the country.
Based on our studies of different immunosuppressive regimens in primates, we have been the first to show that belatacept prevents rejection in VCA in primates and controls rejection in humans. We are currently investigating this approach in a clinical trial of hand transplant recipients (NCT02310867). This clinical trial aims to determine the safety and efficacy of hand transplantation as a treatment for patients with limb loss. This study will also test the efficacy of belatacept to prevent rejection of the transplanted hand. We are also currently investigating in a clinical trial the efficacy of abdominal wall transplantation for the reconstruction of abdominal wall defects (NCT03310905).
Education and Training
- Fellow, Translational Research, Emory University School of Medicine, 2009 - 2011
- Senior Clinical Fellow, National Institutes of Health, 2004 - 2006
- Fellow, Transplantation Surgery, National Institutes of Health, 2001 - 2004
- Clinical Fellow & Senior Fellow, Hand & Microsurgery, Christine M. Kleinert Institute, 1997 - 2001
- Chief Resident, Surgery, Hospital General Dr. Manuel Gea Gonzalez (Mexico), 1995 - 1996
- Internship/Junior Resident, Surgery, Hospital General Dr. Manuel Gea Gonzalez (Mexico), 1993 - 1995
- M.D., Universidad Autonoma Metropolitana (Mexico), 1992
In the News
- She Lost Her Hands and Feet. A Duke Surgeon Changed Her LifeFebruary 26, 2019
- Rene Chavez: North Carolina's first hand transplantSeptember 9, 2016
- N.C.'s first hand transplant goes to man from TexasJune 9, 2016
- Texas man receives N.C.’s first hand transplant at DukeJune 9, 2016
- Hospital tour gives middle schoolers new outlook on career in medicineApril 14, 2016
- Duke Surgery Helping Wounded WarriorsDecember 3, 2015
- Duke introduces hand transplant -- first in North CarolinaOctober 7, 2015
- Duke Establishes First Hand Transplant Program in North CarolinaOctober 6, 2015
- Targeting Dormant Breast Cancer Micrometastases to Prevent Disease Relapse
- Immunomodulation to Optimize Vascularized Composite Allograft Integration for Limb Loss Therapy
- Positioning Vascilarized Composite Allotramsplantation within the Spectrum of Transplantation
- Development of a Composite Tissue Allotransplantation Research Program