Advances in composite tissue allograft transplantation as related to the hand and upper extremity.
The clinical transplantation of composite tissue allografts (CTA) such as human hand or larynx is stimulating discussions among surgeons at national and international forums on the indications, ethical aspects, toxic effects of immunosuppression, and functional results of the first reported cases of unilateral and bilateral hand transplantation. This Clinical Perspective article presents the latest advances in clinical and experimental research related to the field of CTAs. The article presents the historic aspects of CTA, a broad view of the current state of composite tissue transplantation, the mechanism of allograft rejection, current experimental and clinical protocols, and, finally, the future prospects of the standard use of CTAs. It is clear that there is a substantial demand for routine use of CTAs but the treatment protocols need to be optimized and the functional outcomes need to be improved.
Department of Plastic Surgery, The Cleveland Clinic Foundation, A60, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Maria
M
Siemionow
Kagan
K
Ozer
D000818:Animals; D016026:Bone Marrow Transplantation / Q000276:immunology; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use; D006084:Graft Rejection; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D023421:Models, Animal; D013601:T-Lymphocytes / Q000276:immunology; D016559:Tacrolimus / Q000627:therapeutic use; D014181:Transplantation Immunology / Q000276:immunology / Q000502:physiology*; D023001:Transplantation Tolerance / Q000187:drug effects / Q000276:immunology / Q000502:physiology*; D014184:Transplantation, Homologous
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus