Composite tissue allotransplantation: a review of relevant immunological issues for plastic surgeons.
BACKGROUND
Composite tissue allotransplantation of hand, facial and other tissues is now a clinical reality. The terminology, treatment principles, drug combinations, dosage schedules and mechanisms of the immunosuppression medications on which contemporary transplant surgery is based are unfamiliar to plastic surgeons and most healthcare providers outside the field of transplantation medicine. With this in mind, the purpose of this manuscript is to provide plastic surgeons with a comprehensive and understandable review of key immunological principles relevant to composite tissue allotransplantation.


METHODS
We present an overview of the immunological basis of composite tissue allotransplantation aimed at the plastic surgery readership, based on our own experience plus manuscripts sourced from MEDLINE, EMBASE, text books, ancient manuscripts and illustrations.


RESULTS
In this manuscript we provide the reader with a brief history of composite tissue allotransplantation (CTA), a concise description of the immunological terminology, treatment approaches, risks associated with immunosuppressive therapy, risk acceptance, and current research avenues relating to contemporary CTA.


CONCLUSIONS
Today, as transplant and reconstructive surgeons join forces to move hand and facial tissue allotransplantation into the clinical arena, it is important that plastic surgeons have an understanding of the major immunological principles upon which this new treatment is based.
Whitaker
Iain S
IS
Department of Surgery, University of Louisville, 511 South Floyd Street, 320 MDR Building, Louisville, KY 40202, USA.
Duggan
Eileen M
EM
Alloway
Rita R
RR
Brown
Charlie
C
McGuire
Sean
S
Woodle
E Steve
ES
Hsiao
Eugene C
EC
Maldonado
Claudio
C
Banis
Joseph C
JC
Barker
John H
JH
D054445:Facial Transplantation; D006084:Graft Rejection; D063987:Hand Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D009626:Terminology as Topic; D016378:Tissue Transplantation; D014181:Transplantation Immunology / Q000276:immunology