Could you tell us a bit about yourself?
I am a 4th year medical student at Imperial College London, currently studying for an intercalated degree in surgery and anaesthesia. I have always been keen on plastics which stems from an interest in military medicine as well as the fact that no two plastic surgery procedures are the same. There has been no plastic surgery in my medical school curriculum so I have supplemented this interest through observing in theatre as much as possible.
How did you become involved in VCA research?
My interest in VCA (Vascularised Composite Allograft), commonly known as “face transplantation” stemmed from reading the Lancet paper Facial transplantation: the first 9 years. I had long heard of there being problems related to immune-modulating therapy following VCA and learnt that around 90% of VCA recipients have experienced at least one episode of acute rejection.
It seemed to me that problems with rejection could be an Achilles’ heel for VCA, as without durable long-term graft tolerance, patients remain at risk of immunological problems, chronic and acute rejection as well as both metabolic and neoplastic problems.
I got in touch with Dr Curtis L Cetrulo Jr of Harvard Medical School who co-ordinates the VCA segment of the Transplantation Biology Research Center at Massachusetts General Hospital. Dr Cetrulo invited me to come and get involved in research work over a Summer- the lab team were very welcoming and really made me feel part of the team. During this trip I was fortunate enough to meet two VCA recipients which really inspired me.
On my return to the UK I started looking into British researchers who were publishing in this area, and that is how I found Mr Fadi Issa of Restore. We came up with the idea for our clinical case review: “Investigating the immunological burden after extensive craniofacial burns”. We wanted to look into how the acute management of patients with severe facial burns can affect their long term immunological status and thus suitability for VCA and other transplants in general.
So what were your findings?
We know that heart, kidney and other solid organ transplant recipients and donors are paired via HLA (Human Leukocyte Antigen) matching. However, VCA donor and recipient matching has additional concerns as there is a need to restore both form and function. These aspects can at times take precedence over immunological matching and so there is a need for early appropriate care of facial burns patients who may be eligible for VCA to optimise long term immunology-related outcomes should they undergo this procedure.
What are your hopes for the future?
I look forward to presenting our work with Fadi at the 17th European Burns Association Congress in Barcelona in September 2017 and Restore has supported me closely in this endeavour.
In the future I am keen to continue to collaborate with Restore and utilise the methods I learnt from Harvard to pursue a career in academic surgery. I want to continue researching VCA and would love to be involved in setting up a VCA centre in London.
By Majid Al-Khalil, Restore Student Fellow