How Reconstructive Transplantation Is Different From Organ Transplantation—and How It Is Not

Hautz, Theresa; Brandacher, Gerald; Engelhardt, Timm Oliver; Pierer, Gerhard; Lee, W.P.A.; Pratschke, Johann; Schneeberger, S.

doi:10.1016/j.transproceed.2011.08.044

Cited by 26 publications

(21 citation statements)

References 74 publications

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“…However, monitoring of deep tissues such as arteries will also be mandatory. Skin is not always a perfect marker of rejection (35). …”

Section: Ethical Considerations For Tolerance Induction In Hand Transmentioning

confidence: 99%

Hand transplants and the mandate for tolerance

Koulmanda

Pomahac

Fan

et al. 2014

Current Opinion in Organ Transplantation

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“…However, monitoring of deep tissues such as arteries will also be mandatory. Skin is not always a perfect marker of rejection (35). …”

Section: Ethical Considerations For Tolerance Induction In Hand Transmentioning

confidence: 99%

Hand transplants and the mandate for tolerance

Koulmanda

Pomahac

Fan

et al. 2014

Current Opinion in Organ Transplantation

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“…T-regs and tolerogenic APCs, as well as donor BM infusion and chimerism induction [20,[32][33][34][35][36][37][38][39]. A translational, clinically relevant protocol was recently developed by Mathes et al [40] in a MHC-matched canine model that has led to tolerance to all components of the VCA, including skin using a hematopoietic mixed chimerism protocol with non-myeloablative induction.…”

Section: Cell-based Protocols Principles and Applicationsmentioning

confidence: 99%

Minimization of Immunosuppression and Tolerance Induction in Reconstructive Transplantation

et al. 2012

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Vascularized composite allotransplantation (VCA) is an innovative reconstructive modality for patients sustaining complex injuries not amenable to conventional treatment. Advances in immunosuppression have made VCA a clinical reality and a valid reconstructive option for such patients. The requirement, however, for multi-drug high-dose immunosuppressive regimens with their numerous side effects has hindered widespread clinical application of VCA. There is thus a need for novel immunologic modalities to minimize or even obviate the need for immunosuppression (tolerance induction) while still preserving the allograft and preventing rejection. Recent advances in targeted immunotherapy and cell-based protocols were able to achieve tolerance in selected cases of solid organ transplantation. This paved the way for innovative immunomodulatory protocols now also applied to VCA that aim for minimal immunosuppression or for induction of donor-specific tolerance. These concepts and novel protocols will be discussed in this review.

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“…On this basis, recipient selection has been very stringent thus far in VCA. The majority is physically healthy individuals suffering from severe tissue defects of the face or limbs [30]. Despite the thorough vetting of potential recipients, the observed postoperative complications have largely mirrored those described in solid organ transplantation.…”

Section: Immunology Of Vcamentioning

confidence: 99%

The Need for Inducing Tolerance in Vascularized Composite Allotransplantation

Ravindra

Bozulic

et al. 2012

Clinical and Developmental Immunology

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Successful hand and face transplantation in the last decade has firmly established the field of vascularized composite allotransplantation (VCA). The experience in VCA has thus far been very similar to solid organ transplantation in terms of the morbidity associated with long-term immunosuppression. The unique immunological features of VCA such as split tolerance and resistance to chronic rejection are being investigated. Simultaneously there has been laboratory work studying tolerogenic protocols in animal VCA models. In order to optimize VCA outcomes, translational studies are needed to develop less toxic immunosuppression and possibly achieve donor-specific tolerance. This article reviews the immunology, animal models, mixed chimerism & tolerance induction in VCA and the direction of future research to enable better understanding and wider application of VCA.

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How Reconstructive Transplantation Is Different From Organ Transplantation—and How It Is Not

Cited by 26 publications

References 74 publications

Hand transplants and the mandate for tolerance

Hand transplants and the mandate for tolerance

Minimization of Immunosuppression and Tolerance Induction in Reconstructive Transplantation

The Need for Inducing Tolerance in Vascularized Composite Allotransplantation

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