Episode 19: Transplantation Journals - Behind the Paper - Gerald Brandacher - VCA Chronic Rejection

Gerald Brandacher discusses the recent review “Clinical Manifestation, Mechanisms, and Potential Targets of Intervention for Chronic Rejection in Vascularized Composite Allotransplantation.” As vascularized composite allotransplantation (VCA) has matured, chronic rejection has become a key determinant of long-term graft outcomes. Unlike solid organ transplantation, VCAs involve multiple tissue types—including skin, vessels, and adnexal structures—each with distinct clinical and pathological patterns of chronic rejection. In this Behind the Paper interview, Dr. Brandacher reflects on the current state of the VCA field and examines how environmental, physical, and thermal trauma can trigger or worsen both acute and chronic rejection. The discussion spans clinical presentation in human and animal models, evolving pathological classifications, and the mechanisms underlying chronic rejection and transplant vasculopathy. The conversation also explores emerging approaches to monitoring and intervention, including complement-targeted therapies and checkpoint inhibitors, as well as insights drawn from related disease states such as pulmonary arterial hypertension. Together, these perspectives point toward future directions for improving diagnosis, prevention, and treatment of chronic rejection in VCA. Read the publication: https://journals.lww.com/transplantjournal/abstract/2025/11000/clinical_manifestation,_mechanisms,_and_potential.12.aspx — About the Journal Transplantation is the official journal of The Transplantation Society. Published monthly, it is one of the most highly cited journals in the field, with more than 25,000 citations per year. https://transplantjournal.com — The Transplantation Society Learn more about the journal and society initiatives: https://tts.org/journal/transplantation