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Introduction: The clinical significance of donor-specific anti-HLA antibodies (DSAs) in vascularized composite allotransplantation is not clear, even though their occurrence has been reported by several teams. The aim of the present multicenterc study was to assess the incidence of DSAs in upper extremity (UET) and face transplanted patients and their influence on patient outcomes.Methods and Results: Pre- and post-transplantation sera of 37 patients (23 UET, 13 face transplantations and 1 simultaneous UET and face transplantation) were screened in a single laboratory using a solid phase assay. The recipients included 29 men and 8 women, median age was 33 years. Their immunosuppressive treatment, number of HLA mismatches, number of acute rejection (AR) episodes with Banff score, occurrence of graft vasculopathy, chronic rejection and graft loss were collected. In addition, the histological impact of DSA was studied in a small cohort of these patients. For each patient from our cohort with de novo DSA, we randomly selected 2 biopsies taken before and 3 biopsies after the appearance of DSA. DSA were detected in 43.2% of the recipients (16/37), including 6 patients who had presented preformed DSA. The intensity of recipient humoral alloimmune response was estimated using the MFI of positive beads in solid-phase assay. This showed variability both among recipients and among the different DSA specificities of the same patient. From an overall perspective, the alloimmune response was not very strong (median MFI 1413). Donor and recipient age and gender as well as the immunosuppressive treatment were not statistically different between the recipients who developed DSA and those who did not do it. Interesting the number of AR and Banff score did not influence DSA occurrence. No significant correlation between the presence of DSA and chronic rejection, graft vasculopathy or graft loss was found. Five patients with DSA developed chronic rejection and 4 of them graft vasculopathy. In addition, 2 recipients with DSA experienced several episodes of atypical rejections. Longitudinal assessment showed that almost all preformed DSA disappear over time and almost 50% of de novo DSA also in those patients who developed chronic rejection and/or graft vasculopathy with graft loss. There were 5 cases of graft loss and 3 of which had developed DSA during their follow-up. The histopathological study performed on skin sections obtained after the appearance of DSA (routinely-stained and immunolabelled for CD34) did not show significant influx of inflammatory cells into the dermal capillaries endothelial, cell swelling, or microthrombosis.Conclusion: The study confirms that VCA is a sensitizing event for recipients. However, the evolution of DSA over time seems rather heterogeneous. Pre-formed DSAs tend to disappear rapidly and potentially no longer be deleterious, contrary to de novo DSA whose evolution and pathogenicity remain to be elucidated. Longer follow-up will allow to better assess the outcomes of the patients who developed DSA.

In the midst of the COVID-19 pandemic and the universal chaos created by it, this study explores the role of sense of coherence (Soc, Antonovsky, 1979) and how it enables coping with a stressful situation and staying well. SOC is a generalized orientation which allows one to perceive the world as comprehensible, manageable, and meaningful. In an attempt to understand ‘how does the SOC work’ we employed the salutogenic assumption that a strong SOC allows one to reach out in any given situation and find those resources appropriate to the specific stressor. Thus, we hypothesized that the positive impact of SOC on mental health outcomes would be mediated through coping resources that are particularly salient in times of crisis. One resource is related to the micro level (perceived family support) and the other concerns the macro level (trust in leaders and social-political institutions). Data collection was conducted in different countries during May–June 2020 via online platforms. The data included 7 samples of adult participants (age 18–90) from Israel (n ​= ​669), Italy (n ​= ​899), Spain (n ​= ​476), Germany (n ​= ​708), Austria (n ​= ​1026), Switzerland (n ​= ​147), and the U.S. (n ​= ​506). The questionnaires included standard tools (MHC-SF, SOC-13) as well as questionnaires of perceived family support and trust that were adapted to the pandemic context. As expected, SOC was associated with mental health in all the samples. Perceived family support and trust in leaders and social-political institutions mediated the relationships between SOC and mental health, controlling for age, gender, and level of financial risk. It appears that SOC has a universal meaning, not limited by cultural and situational characteristics. The discussion focuses on the theoretical, social, and political applications of the salutogenic model – and its core concept of SOC – in the context of coping with a global pandemic across different cultural contexts and countries.