title: Transplantation of the hand, face, and composite structures: evolution and current status.
abstract: This article reviews the world experience in the newly emerging field of composite tissue allotransplantation. These allografts contain multiple tissues that are usually musculoskeletal structures with a skin or epithelial surface, such as hand, facial structures, larynx, tongue, ear, knee/femur, abdominal wall, and penis. They represent a new transplantation field, with only a 10-year experience and just over 50 clinical cases. This review of the 10-year world experience found uniform technical success, immunologic biology, and immunosuppression regimens very similar to solid organ transplants, and success strongly correlated with adherence to guidelines for psychiatric screening, thorough preparation of patient and families, intense postoperative monitoring, and assurance of medication access. All failures reported have been caused by lapses in these parameters. This early experience shows a great potential for application of these new procedures to the most challenging reconstructive needs.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Louisville, Louisville, KY 40292, USA. lauralea.witt@louisville.edu
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Tobin
authors.forename: Warren C
authors.initials: WC
authors.lastname: Breidenbach
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Pidwell
authors.forename: Suzanne T
authors.initials: ST
authors.lastname: Ildstad
authors.forename: Kadiyala V
authors.initials: KV
authors.lastname: Ravindra
mesh_terms: D004423:Ear / Q000601:surgery; D005145:Face / Q000601:surgery*; D005269:Femur / Q000637:transplantation; D063987:Hand Transplantation; D006801:Humans; D007717:Knee / Q000601:surgery; D007830:Larynx / Q000637:transplantation; D016378:Tissue Transplantation / Q000639:trends*; D014059:Tongue / Q000637:transplantation; D014184:Transplantation, Homologous / Q000379:methods*