Vascularized Composite Allotransplantation is an emerging new era in transplant medicine and has become a viable reconstructive option for patients with extensive tissue defects and severe dysfunction. Advances in microsurgical techniques, transplant immunology and the development of potent immunosuppressive agents have enabled the realization of such novel transplants. Over the past 2 decades, a rapidly growing number of face and upper extremity transplants have been performed worldwide. The outcomes have been highly encouraging and more and more centers and institutions continue to embark on this exciting venture. Currently there are 17 academic centers in the US alone that are registered with the United Network for Organ Sharing (UNOS) to perform face and extremity transplantation and many more are in the process of launching reconstructive transplantation programs.
However, much of our current understanding regarding immunology, mechanisms of acute and chronic rejection and immune monitoring of vascularized composite allografts have been extrapolated from basic and clinical studies of solid organ transplantation. To justify the risk-benefit ratio for VCA, which are generally life-changing but not life-saving transplants, the risks and toxicities of long-term immunosuppressive medication need to be carefully balanced against the potential benefits. These benefits, although not life-saving, can be substantial, including return in motor and sensory function, independence, and improvement in quality of life. In addition, vascularized composite allografts show differences with regard to immunobiology that may be advantageous relative to solid organ transplants. For the first time in the history of transplantation we have the ability to actually constantly monitor the graft by simple visual inspection of the skin component that allows for early diagnosis and individualized treatment of rejection as well as offers unprecedented opportunities for advanced immune monitoring. Since some vascularized composite allografts include bone marrow and a vascularized bone marrow niche, these immunocompetent elements may favorably modulate the host immune response and aid in tolerogeneic protocols via mixed chimerism induction or other cell-based immunomodulatory regimens. Those features offer an exciting opportunity not only to help advance our basic understanding of the mechanisms of immune tolerance but also the organ-specific nature of the alloimmune response in general as well as responses specific to vascularized composite allografts.
Upper extremity, face, and abdominal wall are currently the most frequently performed types of reconstructive transplants. However, the scientific advancements, clinical successes, and highly encouraging outcomes have sparked ambitions to further expand indications to include lower extremity transplants, pediatric patients, and urogenital transplants in the foreseeable future as a restorative treatment to replace “like-with-like” tissue.
Clearly, reconstructive transplantation is now a reality, and basic and translational research in this field is advancing on many fronts, bringing greater attention and focus to the field. However, there is currently no dedicated forum for this new and exciting discipline, where experts and investigators may share their experience and new findings. We therefore believe that this new journal devoted to VCA will fit well into the modern day landscape of scientific publishing. With the ongoing and significant increase in basic and translational research as well as a constantly increasing number of patients worldwide in the field of reconstructive transplantation, this journal will fill a niche by publishing high-quality, peer-reviewed scientific articles on a broad range of topics including organ/tissue preservation, ischemia reperfusion injury, mechanisms of skin rejection, immune regulation and tolerance induction, experimental immunosuppression and immune monitoring, nerve regeneration and cortical reintegration, as well as surgical techniques, and clinical trials and protocols.
We have therefore endeavored to establish Vascularized Composite Allotransplantation as the first multidisciplinary, peer-reviewed, international journal to focus exclusively on this new discipline. The content of this journal is directed toward both basic scientists and clinicians, with the aim of delivering the most complete and reliable source of information on current developments and advances in this novel field of transplantation.
VCA will publish several types of manuscripts including Original Articles, Clinical Studies and Case Reports, Reviews, Commentaries, and highlights from meetings devoted to Vascularized Composite Allotransplantation. Reviews will generally be commissioned, but unsolicited submissions are welcome. Special issues dedicated to particular types of vascularized composite allografts are also anticipated. We will strive and make every effort to handle submissions swiftly and fairly, provide constructive, high-quality reviews, and ensure a rapid turnaround of our community's work, taking advantage of the state-of-the-art infrastructure and latest electronic technologies provided by the publisher Taylor & Francis Group, LLC (T&F).
Although the omnipresence and immediacy of the Internet has boosted the move toward online publication, some readers still prefer the feel, the smell or simply the aesthetics of the print version. We thus decided to preserve for VCA the very best of hard-copy publishing while taking full advantage of new electronic platforms and online opportunities by providing both online and optional printed formats of the journal.
Furthermore, we were delighted to see the worldwide support for this initiative as evidenced by the group of outstanding Associate Editors and the prestigious scientific Editorial Board including many of the pioneers and foremost leaders in the field who are committed to the mission and scope of VCA and who will contribute their expertise to the journal. This group of individuals represents a remarkable breadth and depth of experience and knowledge that is demanded by a diverse and multi-disciplinary field like ours. Review of each manuscript will be coordinated primarily by the Editor-in-Chief with the assignment of this responsibility based on expertise rather than geography. Suggestions from authors for editorial assignments are welcome.
We work actively with T&F, the publisher of VCA, on indexing and coverage of the journal in numerous databases. Our objective is to achieve inclusion in PubMed Central/PubMed at the National Library of Medicine within 12–18 months. This will support permanent archiving and increase the distribution of articles published in the journal. Further indexing will take place as soon as content allows for it.
Thus, our collective goal for VCA is to bring its readers cutting-edge, original research in all areas of vascularized composite allotransplantation that will stimulate new thinking and advances in the field as well as build a bridge between basic research and clinical practice.
We hope you share our enthusiasm for this exciting new venture of VCA and are greatly looking forward to working with and hearing from readers and authors. As the field of reconstructive transplantation grows and new research directions unfold, it is our desire that VCA will provide a forum for continuing expansion and exchange of new knowledge that ultimately will translate into improved and optimized care for our patients.
Gerald Brandacher, MD
Editor-in-Chief
David H. Sachs, MD
W. P. Andrew Lee, MD
Co-Editors-in-Chief