title: The immunologic considerations in human head transplantation.
abstract: The idea of head transplantation appears at first as unrealistic, unethical, and futile. Here we discuss immunological considerations in human head transplantation. In a separate accompanying article we discuss surgical, ethical, and psychosocial issues concerned in body-to-head transplantation (BHT) [1]. The success of such an unusual allograft, where the donor and the recipient can reject each other, depends on prevention of complex immunologic reactions, especially rejection of the head by the body (graft-vs-host) or probably less likely, the possibility of the head rejecting the total body allograft (host-vs-graft). The technical and immunologic difficulties are enormous, especially since rapid nerve and cord connections and regeneration have not yet been possible to achieve. In this article we begin by briefly reviewing neuro-immunologic issues that may favor BHT such as the blood brain barrier (BBB) and point out its shortcomings. And we touch on the cellular and humoral elements in the brain proper that differ in some respects from those in other organs and in the periphery. Based on recent successes in vascular composite allografts (VCAs), we will elaborate on potential specific advantages and difficulties in BHT of various available immunosuppressive medications already utilized in VCAs. The risk/benefit ratio of these drugs will be emphasized in relation to direct brain toxicity such as seizure disorders, interference, or promotion of nerve regeneration, and potentiation of cerebral viral infections. The final portion of this article will focus on pre-transplant immunologic manipulation of the deceased donor body along with pretreatment of the recipient.
authors.affiliation: Department of Surgery, Transplantation Program, Columbia University College of Physicians and Surgeons, 161 Fort, Washington Ave., Herbert Irving Pavilion 5-549, New York, NY, 10032, USA. Electronic address: mah1@cumc.columbia.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hardy
authors.affiliation: Haley Center 7018, Auburn University, Auburn, AL, 36849, USA. Electronic address: allen.furr@auburn.edu.
authors.forename: Allen
authors.initials: A
authors.lastname: Furr
authors.affiliation: Department of Plastic Surgery and Burns, Burn Services, Face and Hand Transplantation Program, University Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain. Electronic address: jpbarret@vhebron.net.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Barret
authors.affiliation: Frankfurt Initiative for Regenerative Medicine, Experimental Orthopedics & Trauma Surgery, J.W. Goethe-University, Friedrichsheim Orthopedic Hospital, Haus 97 B, 1OG, Marienburgstr. 2, 60528, Germany Frankfurt/Main, Germany. Electronic address: JHB121654@gmail.com.
authors.forename: John H
authors.initials: JH
authors.lastname: Barker
mesh_terms: D016380:Brain Tissue Transplantation / Q000379:methods; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology*; D006257:Head; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016377:Organ Transplantation / Q000379:methods*; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents
keywords: Composite tissue allotransplantation; Frontiers in surgery; Head transplantation; Reconstructive transplant surgery; Tolerance; Vascularized composite allografts rejection