title: Composite tissue allotransplantation: past, present and future-the history and expanding applications of CTA as a new frontier in transplantation.
abstract: Composite tissue allotransplantation (CTA) transplantation is currently being performed with increasing frequency in the clinic. The feasibility of the procedure has been confirmed in over 40 successful hand transplants, 3 facial reconstructions, and vascularized knee, esophageal, abdominal wall, and tracheal allografts. The toxicity of chronic, nonspecific immunosuppression remains a major limitation to the widespread availability of CTA and is associated with opportunistic infections, nephrotoxicity, end-organ damage, and an increased rate of malignancy. Methods to reduce or eliminate the requirement for immunosuppression would represent a significant step forward in the field. Mixed chimerism induces tolerance to solid organ and tissue allografts, including CTA. This overview focuses on the history and expanding applications of CTA as a new frontier in transplantation, and considers the important hurdles that must be overcome through research to allow widespread clinical application.
authors.affiliation: Institute for Cellular Therapeutics, University of Louisville, Louisville, Kentucky, USA.
authors.forename: S
authors.initials: S
authors.lastname: Wu
authors.forename: H
authors.initials: H
authors.lastname: Xu
authors.forename: K
authors.initials: K
authors.lastname: Ravindra
authors.forename: S T
authors.initials: ST
authors.lastname: Ildstad