To summarize diagnostic advances and challenges in vascularized composite allotransplantation (VCA) and identify emerging tools for improved rejection monitoring.
Key Findings:
The Banff 2022 revision introduced vascular modifiers to capture chronic vascular injury.
Mucosal rejection may occur earlier or more severely than cutaneous rejection.
Molecular assays such as donor-derived cell-free DNA and miRNA profiling show promise for early detection of rejection.
Interpretation:
Key challenges include variability in biopsy interpretation, absence of validated molecular criteria, and limited integration of multimodal data into clinical workflows, which can hinder timely diagnosis.
Limitations:
Interobserver variability in biopsy interpretation can lead to inconsistent diagnoses.
Lack of validated molecular and biomarker criteria limits diagnostic reliability.
Limited integration of multimodal data into clinical workflows restricts comprehensive patient assessment.
Conclusion:
Coordinated multicenter efforts are needed to standardize evaluation methods and improve early, accurate diagnosis, potentially through shared protocols and data integration.
