A systematic review of autologous transplantation methods in vitiligo

Objective: A systematic review of the effectiveness, safety, and applicabil ity of autologous transplantation methods in vitiligo. Data Sources: Computerized searches of bibliographical databases, a complem entary manual literature search, and contacts with researchers and pharmace utical firms. Study Selection: Predefined selection criteria were applied to all studies found. Data Extraction: Two investigators independently assessed the articles for inclusion. When there was a disagreement, a third investigator was consulte d. Data Synthesis: Sixty-three studies were found, of which 16 reported on min igrafting, 13 on split-thickness grafting, 15 on grafting of epidermal blis ters, 17 on grafting of cultured melanocytes, and 2 on grafting of noncultu red epidermal suspension. Of these, 39 patient series were included. The hi ghest mean success rates (87%) were achieved with split-skin grafting (95% confidence interval, 82%-91%), and epidermal blister grafting (87%) (95% co nfidence interval, 83%-90%). The mean success rate of 5 culturing technique s varied from 13% to 53%. However, in 4 of the 5 culturing methods, fewer t han 20 patients were studied. Minigrafting had the highest rates of adverse effects but was the easiest, fastest, and least expensive method. Conclusions: Because no controlled trials were included, treatment recommen dations should be formulated with caution. Split-thickness and epidermal bl ister grafting can be recommended as the most effective and safest techniqu es. No definite conclusions can be drawn about the effectiveness of culturi ng techniques because only a small number of patients have been studied. Th e choice of method also depends on certain disease characteristics and the availability of specialized personnel and equipment.