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Long-Term Prevention of Rejection and Combination Drug Therapy

  • Thomas H. Tung

This chapter provides an overview of the use of the most current immunosuppressive medications in composite tissue transplantation, and the immunological issues regarding the long-term survival of tissue allografts. Because the clinical application of composite tissue transplantation has been either anecdotal (laryngeal, bone, tendon) or recent (hand transplantation), the risk of late allograft loss is for the most part extrapolated from the organ transplantation literature. Peripheral nerve transplantation is unique because the nerve allograft provides only a temporary scaffold to guide host nerve regeneration; immunosuppressive medication is required for only a couple of years, and long-term allograft survival is not relevant. On the basis of the experience in organ transplantation, chronic rejection remains a significant and unsolved problem despite the use of the most potent immunosuppressive drugs. Since composite tissue transplantation improves quality of life but is nonvital, allograft longevity will continue to be a critical issue in the justification of hand and face transplantation.

Keywords

Acute Rejection Chronic Rejection Allograft Survival Acute Rejection Episode Combination Drug Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    D. Slome and B. Reeves, Experimental homotransplantation of the knee-joint, Lancet 2, 205 (1966).PubMedCrossRefGoogle Scholar
  2. 2.
    R. M. Goldwyn, P. M. Beach, D. Feldman, and R. E. Wilson, Canine limb homotransplantations, Plast Reconstr Surg 37, 184 (1966).PubMedCrossRefGoogle Scholar
  3. 3.
    Doi K, Homotransplantation of limbs in rats, Plast Reconstr Surg 64, 613–621 (1979).PubMedCrossRefGoogle Scholar
  4. 4.
    E. M. Lance, A. E. Inglis, F. Figarola, and F. J. Veith, Transplantation of the canine hind limb, J Bone Joint Surg 53A, 1137 (1971).Google Scholar
  5. 5.
    V. Goldberg, B. B. Porter, and E. M. Lance, Transplantation of the canine knee joint on vascular pedicles, J Bone Joint Surg 55A, 1314 (1973).Google Scholar
  6. 6.
    J. F. Borel, C. Feurer, H. U. Gubler, and H. Stahelin, Biological effects of cyclosporine A: A new antilymphocytic agent, Agents Actions 6, 468 (1976).PubMedCrossRefGoogle Scholar
  7. 7.
    R. Y. Calne, D. J. White, K. Rolles, D. P. Smith, and B. M. Herbertson, Prolonged survival of pig orthotopic heart grafts treated with cyclosporin A, Lancet 1, 1183–1185 (1978).PubMedCrossRefGoogle Scholar
  8. 8.
    A. B. Cosimi, C. F. Shield, C. Peters, R. C. Burton, G. Scott, and P. S. Russell. Prolongation of allograft survival by cyclosporin A, Surg Forum 30, 287–289. 1979.PubMedGoogle Scholar
  9. 9.
    R. Y. Calne, D. J. White, B. D. Pentlow, K. Rolles, T. Syrakos, T. Ohtawa, D. P. Smith, P. McMaster, D. B. Evans, B. M. Herbertson, and S. Thiru, Cyclosporin A: Preliminary observations in dogs with pancreatic duodenal allografts and patients with cadaveric renal transplants, Transplant Proc 11, 860–864 (1979).PubMedGoogle Scholar
  10. 10.
    B. A. Reitz, N. A. Burton, S. W. Jamieson, C. P. Bieber, J. L. Pennock, E. B. Stinson, and N. E. Shumway, Heart and lung transplantation: Autotransplantation and allotransplantation in primates with extended survival, J Thorac Cardiovasc Surg 80, 360–372 (1980).PubMedGoogle Scholar
  11. 11.
    K. S. Black, C. W. Hewitt, L. A. Fraser, J. G. Osborne, B. M. Achauer, D. C. Martin, and D. W. Furnas, Cosmas and Damian in the laboratory, N Eng J Med 306, 368–369 (1982).Google Scholar
  12. 12.
    S. E. Hovius, H. P. Stevens, P. W. van Nierop, W. Rating, R. van Strik, and J. H. van der Meulen, Allogeneic transplantation of the radial side of the hand in the rhesus monkey: I. Technical aspects, Plast Reconstr Surg 89, 700–709 (1992).PubMedCrossRefGoogle Scholar
  13. 13.
    K. S. Black, C. W. Hewitt, J. S. Hwang, R. W. Borger, and B. M. Achauer, Dose response of cyclosporine-treated composite tissue allografts in a strong histoincompatible rat model, Transplant Proc 20, 266–268 (1988).PubMedGoogle Scholar
  14. 14.
    H. Kuroki, O. Ishida, H. Daisaku, K. Fukuhara, E. Hatano, T. Murakami, Y. Ikuta, A. K. Matsumoto, and M. Akiyama, Morphological and immunological analysis of rats with long-term-surviving limb allografts induced by a short course of FK506 or cyclosporine, Transplant Proc 23, 516–520 (1991).PubMedGoogle Scholar
  15. 15.
    T. Hotokebuchi, K. Arai, K. Takagishi, C. Arita, Y. Sugioka, and N. Karibara, Limb allografts in rats immunosuppressed with cyclosporine: As a whole-joint allograft, Plast Reconstr Surg 83, 1027–1036 (1989).PubMedGoogle Scholar
  16. 16.
    T. Goto, T. Kino, H. Hatanaka, M. Nishiyama, M. Okuhara, M. Kohsaka, H. Aoki, and H. Imanaka, Discovery of FK-506, a novel immunosuppressant isolated from Streptomyces tsukubaensis, Transplant Proc 19, 4–8 (1987).PubMedGoogle Scholar
  17. 17.
    H. Kuroki, Y. Ikuta, and M. Akiyama, Experimental studies of vascularized allogeneic limb transplantation in the rat using a new immunosuppressive agent FK-506: Morphological and immunological analysis, Transplant Proc 21, 3187–3190 (1989).PubMedGoogle Scholar
  18. 18.
    Z. Min and N. F. Jones, Limb transplantation in rats: Immunosuppression with FK-506, J Hand Surg 20A, 77–87 (1995).Google Scholar
  19. 19.
    K. Arai, T. Hotokebuchi, H. Miyahara, C. Arita, M. Mohtai, Y. Sugioka, and N. Kaibara, Prolonged limb allograft survival with short-term treatment with FK-506 in rats, Transplant Proc 21, 3191–3193 (1989).PubMedGoogle Scholar
  20. 20.
    K. Arai, T. Hotokebuchi, H. Miyahara, C. Arita, M. Mohtai, Y. Sugioka, and N. Kaibara, Limb allografts in rats immunosuppressed with FK506. I. Reversal of rejection and indefinite survival, Transplantation 48, 782–786 (1989).PubMedCrossRefGoogle Scholar
  21. 21.
    R. Buttemeyer, N. F. Jones, Z. Min, and U. Rao, Rejection of the component tissues of limb allografts in rats immunosuppressed with FK-506 and cyclosporine, Plast Reconstr Surg 97, 139–148 (1996).PubMedCrossRefGoogle Scholar
  22. 22.
    W. P. Lee and D. W. Mathes, Hand transplantation: Pertinent data and future outlook, J Hand Surg [Am] 24, 906–913 (1999).CrossRefGoogle Scholar
  23. 23.
    T. S. Mele and P. F. Halloran, The use of mycophenolate mofetil in transplant recipients, Immunopharmacology 47, 215–245 (2000).PubMedCrossRefGoogle Scholar
  24. 24.
    D. B. Kaufman, R. Shapiro, M. R. Lucey, W. S. Cherikh, T. Bustami, and D. B. Dyke, Immunosuppression: Practice and trends, Am J Transplant 4 Suppl 9, 38–53 (2004).PubMedCrossRefGoogle Scholar
  25. 25.
    R. E. Morris, E. G. Hoyt, E. M. Eugui, and A. C. Allison, Transplantation and its immunology. Prolongation of rat heart allograft survival by RS-61443, Surg Forum 7, 337–338 (1989).Google Scholar
  26. 26.
    R. E. Morris, E. G. Hoyt, M. P. Murphy, E. M. Eugui, and A. C. Allison, Mycophenolic acid morpholinoethylester (RS-61443) is a new immunosuppressant that prevents and halts heart allograft rejection by selective inhibition of T- and B-cell purine synthesis, Transplant Proc 22, 1659–1662 (1990).PubMedGoogle Scholar
  27. 27.
    H. W. Sollinger, E. M. Eugui, and A. S. Allison, RS-61443: Mechanisms of action, experimental and early clinical results, Clin Transplant 5, 523–526 (1991).Google Scholar
  28. 28.
    H. W. Sollinger, F. O. Belzer, M. H. Deierhoi, A. G. Diethelm, T. A. Gonwa, R. S. Kauffman, G. B. Klintmalm, S. V. McDiarmid, J. Roberts, J. T. Rosenthal, et al., RS-61443 (mycophenolate mofetil). A multicenter study for refractory kidney transplant rejection, Ann Surg 216, 513–518 (1992).PubMedCrossRefGoogle Scholar
  29. 29.
    H. W. Sollinger, M. H. Deierhoi, F. O. Belzer, A. G. Diethelm, and R. S. Kauffman, RS-61443–a phase I clinical trial and pilot rescue study, Transplantation 53, 428–432 (1992).PubMedCrossRefGoogle Scholar
  30. 30.
    R. D. Ensley, M. R. Bristow, S. L. Olsen, D. O. Taylor, E. H. Hammond, et al., The use of mycophenolate mofetil (RS-61443) in human heart transplant recipients. Transplantation 56, 75–82 (1993).PubMedCrossRefGoogle Scholar
  31. 31.
    G. B. Klintmalm, N. L. Ascher, R. W. Busuttil, M. Deierhoi, T. A. Gonwa, R. Kauffman, S. McDiarmid, S. Poplawski, H. Sollinger, and J. Roberts, RS-61443 for treatment-resistant human liver rejection, Transplant Proc 25, 697 (1993).PubMedGoogle Scholar
  32. 32.
    J. K. Kirklin, R. C. Bourge, D. C. Naftel, W. R. Morrow, M. H. Deierhoi, R. S. Kauffman, C. White-Williams, R. I. Nomberg, W. L. Holman, and D. C. Smith, Jr., Treatment of recurrent heart rejection with mycophenolate mofetil (RS-61443): Initial clinical experience, J Heart Lung Transplant 13, 444–450 (1994).PubMedGoogle Scholar
  33. 33.
    P. Benhaim, J. P. Anthony, L. Y. Lin, T. H. McCalmont, and S. J. Mathes, A long-term study of allogeneic rat hindlimb transplants immunosuppressed with RS-61443, Transplantation 56, 911–917 (1993).PubMedCrossRefGoogle Scholar
  34. 34.
    P. Benhaim, J. P. Anthony, L. Ferreira, J. P. Borsanyi, and S. J. Mathes, Use of combination of low-dose cyclosporine and RS-61443 in a rat hindlimb model of composite tissue allotransplantation, Transplantation 61, 527–532 (1996).PubMedCrossRefGoogle Scholar
  35. 35.
    E. T. Ustuner, M. Zdichavsky, X. Ren, J. Edelstein, C. Maldonado, M. Ray, A. W. Jevans, W. C. Breidenbach, S. A. Gruber, J. H. Barker, and J. W. Jones, Long-term composite tissue allograft survival in a porcine model with cyclosporine/mycophenolate mofetil therapy, Transplantation 66, 1581–1587 (1998).PubMedCrossRefGoogle Scholar
  36. 36.
    M. Lanzetta, P. Petruzzo, R. Margreiter, J. M. Dubernard, F. Schuind, W. Breidenbach, S. Lucchina, S. Schneeberger, C. van Holder, D. Granger, G. Pei, J. Zhao, and X. Zhang, The international registry on hand and composite tissue transplantation, Transplantation 79, 1210–1214 (2005).PubMedCrossRefGoogle Scholar
  37. 37.
    M. Aboujaqude, H. Chen, J. Wu, et al., Efficacy of rapamycin in limb transplantation in the rat, Clin Invest Med 14, A146 (1991).Google Scholar
  38. 38.
    S. Inceoglu, M. Siemionow, L. Chick, C. M. Craven, and G. D. Lister, The effect of combined immunosuppression with systemic low-dose cyclosporin and topical fluocinolone acetonide on the survival of rat hind-limb allografts, Ann Plast Surg 33, 57–65 (1994).PubMedCrossRefGoogle Scholar
  39. 39.
    L. S. Yeh, C. R. Gregory, S. M. Griffey, R. A. Lecouteur, and R. E. Morris, Effects of leflunomide and cyclosporine on myocutaneous allograft survival in the rat, Transplantation 62, 861–863 (1996).PubMedCrossRefGoogle Scholar
  40. 40.
    K. Muramatsu, K. Doi, T. Akino, M. Shigetomi, and S. Kawai, Longer survival of rat limb allograft. Combined immunosuppression of FK-506 and 15-deoxyspergualin, Acta Orthop Scand 68, 581–585 (1997).PubMedCrossRefGoogle Scholar
  41. 41.
    L. S. Yeh, C. R. Gregory, S. M. Griffey, R. A. Lecouter, S. M. Hou, and R. E. Morris, Combination leflunomide and cyclosporine prevents rejection of functional whole limb allografts in the rat, Transplantation 64, 919–922 (1997).PubMedCrossRefGoogle Scholar
  42. 42.
    M. Vossen, R. K. Majzoub, J. Edelstein, G. Perez-Abadia, M. Voor, C. Maldonado, T. Tecimer, A. W. Jevans, M. Zdichavsky, J. M. Frank, C. Francois, M. Kon, and J. H. Barker, Bone quality in swine composite tissue allografts: Effects of combination immunotherapy, Transplantation 80, 487–493 (2005).PubMedCrossRefGoogle Scholar
  43. 43.
    M. Vossen, J. Edelstein, R. K. Majzoub, C. Maldonado, G. Perez-Abadia, M. Voor, H. Orhun, T. Tecimer, C. Francois, M. Kon, and J. H. Barker, Bone quality and healing in swine vascularized bone allotransplantation model using cyclosporine-based immunosuppression therapy, Plast Reconstr Surg 115, 529–538 (2005).PubMedCrossRefGoogle Scholar
  44. 44.
    J. C. Guimberteau, J. Baudet, B. Panconi, R. Boileau, and L. Potaux, Human allotransplant of a digital flexion system vascularized on the ulnar pedicle: A preliminary report and 1-year follow-up of two cases, Plast Reconstr Surg 89, 1135–1147 (1992).PubMedCrossRefGoogle Scholar
  45. 45.
    G. O. Hofmann, M. H. Kirschner, F. D. Wagner, W. Land, and V. Buhren, Allogeneic vascularized grafting of a human knee joint with postoperative immunosuppression, Arch Orthop Trauma Surg 116, 125–128 (1997).PubMedCrossRefGoogle Scholar
  46. 46.
    G. O. Hofmann, M. H. Kirschner, F. D. Wagner, L. Brauns, O. Gonschorek, and V. Buhren, Allogeneic vascularized transplantation of human femoral diaphyses and total knee joints–first clinical experiences, Transplant Proc 30, 2754–2761 (1998).PubMedCrossRefGoogle Scholar
  47. 47.
    M. H. Kirschner, L. Brauns, O. Gonschorek, V. Buhren, and G. O. Hofmann, Vascularised knee joint transplantation in man: The first two years experience, Eur J Surg 166, 320–327 (2000).PubMedCrossRefGoogle Scholar
  48. 48.
    M. H. Kirschner, F. D. Wagner, A. Nerlich, W. Land, V. Buhren, and G. O. Hofmann, Allogenic grafting of vascularized bone segments under immunosuppression. Clinical results in the transplantation of femoral diaphyses, Transpl Int 11, 195–203 (1998).PubMedCrossRefGoogle Scholar
  49. 49.
    M. Strome, Human laryngeal transplantation: Considerations and implications, Microsurgery 20, 372–374 (2000).PubMedCrossRefGoogle Scholar
  50. 50.
    M. Strome, J. Stein, R. Esclamado, D. Hicks, R. R. Lorenz, W. Braun, R. Yetman, I. Eliachar, and J. Mayes, Laryngeal transplantation and 40-month follow-up, N Eng J Med 344, 1676–1679 (2001).CrossRefGoogle Scholar
  51. 51.
    Jones JW, Gruber SA, Barker JH, and Breidenbach WC, Successful hand transplantation: One-year follow-up, New Eng J Med 343, 468–473 (2000).PubMedCrossRefGoogle Scholar
  52. 52.
    J. M. Dubernard, E. Owen, N. Lefrancois, P. Petruzzo, X. Martin, M. Dawahra, D. Jullien, J. Kanitakis, C. Frances, X. Preville, L. Gebuhrer, N. Hakim, M. Lanzetta, H. Kapila, G. Herzberg, and J. P. Revillard, First human hand transplantation. Case report. Transpl Int 13 Suppl 1, S521–S524 (2000).PubMedCrossRefGoogle Scholar
  53. 53.
    J. Kanitakis, D. Jullien, P. Petruzzo, N. Hakim, A. Claudy, J. P. Revillard, E. Owen, and J. M. Dubernard, Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation 76, 688–693 (2003).PubMedCrossRefGoogle Scholar
  54. 54.
    C. G. Francois, W. C. Breidenbach, C. Maldonado, T. P. Kakoulidis, A. Hodges, J. M. Dubernard, E. Owen, G. Pei, X. Ren, and J. H. Barker, Hand transplantation: Comparisons and observations of the first four clinical cases. Microsurgery 20, 360–371 (2000).PubMedCrossRefGoogle Scholar
  55. 55.
    J. M. Dubernard, P. Petruzzo, M. Lanzetta, H. Parmentier, X. Martin, M. Dawahra, N. S. Hakim, and E. Owen, Functional results of the first human double-hand transplantation, Ann Surg 238, 128–136 (2003).PubMedCrossRefGoogle Scholar
  56. 56.
    Mackinnon SE, Doolabh VB, Novak CB, and Trulock EP, Clinical outcome following nerve allograft transplantation, Plast Reconstr Surg 107, 1419–1429 (2001).PubMedCrossRefGoogle Scholar
  57. 57.
    S. Hettiaratchy, M. A. Randolph, F. Petit, W. P. Lee, and P. E. Butler, Composite tissue allotransplantation–a new era in plastic surgery? Br J Plast Surg 57, 381–391 (2004).PubMedCrossRefGoogle Scholar
  58. 58.
    M. R. Hausman, J. Masters, and A. Panozzo, Hand transplantation: Current status, Mt Sinai J Med 70, 148–153 (2003).PubMedGoogle Scholar
  59. 59.
    H. D. Kvernmo, V. S. Gorantla, R. N. Gonzalez, and W. C. Breidenbach, III, Hand transplantation. A future clinical option? Acta Orthop 76, 14–27 (2005).PubMedCrossRefGoogle Scholar
  60. 60.
    B. Graham, P. Adkins, T. M. Tsai, J. Firrell, and W. C. Breidenbach, Major replantation versus revision amputation and prosthetic fitting in the upper extremity: A late functional outcomes study, J Hand Surg [Am] 23, 783–791 (1998).CrossRefGoogle Scholar
  61. 61.
    K. L. Womer, R. S. Lee, J. G. Madsen, and M. H. Sayegh, Tolerance and chronic rejection, Phil Trans R Soc Lond B 356, 727–738 (2001).CrossRefGoogle Scholar
  62. 62.
    J. D. Hosenpud, L. E. Bennett, B. M. Keck, M. M. Boucek, and R. J. Novick, The registry of the international society for heart and lung transplantation: Eighteenth official report-2001, J Heart Lung Transplant 20, 805–815 (2001).PubMedCrossRefGoogle Scholar
  63. 63.
    S. Z. Gao, J. S. Schroeder, E. L. Alderman, S. A. Hunt, H. A. Valantine, V. Wiederhold, and E. B. Stinson, Prevalence of accelerated coronary artery disease in heart transplant survivors. Comparison of cyclosporine and azathioprine regimens, Circulation 80, III100–III105 (1989).PubMedGoogle Scholar
  64. 64.
    M. S. Orloff, E. M. DeMara, M. L. Coppage, N. Leong, M. A. Fallon, J. Sickel, X. J. Zuo, J. Prehn, and S. C. Jordan, Prevention of chronic rejection and graft arteriosclerosis by tolerance induction, Transplantation 59, 282–288 (1995).PubMedCrossRefGoogle Scholar
  65. 65.
    Cecka JM and Terasaki PI, The UNOS Scientific Renal Transplant Registry. In Clinical Transplants 1994, ed. by Terasaki PI and Cecka JM, pp. 1–18. UCLA Tissue Typing Laboratory, Los Angeles, CA (1994).Google Scholar
  66. 66.
    A. Tejani and E. K. Sullivan, The impact of acute rejection on chronic rejection: A report of the North American Pediatric Renal Transplant Cooperative Study, Pediatric Transplantation 4, 107–111 (2000).PubMedCrossRefGoogle Scholar
  67. 67.
    A. Lindholm, S. Ohlman, D. Albrechtsen, G. Tufveson, H. Persson, and N. H. Persson, The impact of acute rejection episodes on long-term graft function and outcome in 1347 primary renal transplants treated by 3 cyclosporine regimens, Transplantation 56, 307–315 (1993).PubMedCrossRefGoogle Scholar
  68. 68.
    S. Hariharan, C. P. Johnson, B. A. Bresnahan, S. E. Taranto, M. J. McIntosh, and D. Stablein, Improved graft survival after renal transplantation in the United States, 1988 to 1996, N Engl J Med 342, 605–612 (2000).PubMedCrossRefGoogle Scholar
  69. 69.
    G. P. Basadonna, A. J. Matas, K. J. Gillingham, W. D. Payne, D. L. Dunn, D. E. Sutherland, P. F. Gores, R. W. Gruessner, and J. S. Najarian, Early versus late acute renal allograft rejection: Impact on chronic rejection, Transplantation 55, 993–995 (1993).PubMedCrossRefGoogle Scholar
  70. 70.
    M. J. Brenner, J. N. Jensen, J. B. Lowe, III, T. M. Myckatyn, I. K. Fox, D. A. Hunter, T. Mohanakumar, and S. E. Mackinnon, Anti-CD40 ligand antibody permits regeneration through peripheral nerve allografts in a nonhuman primate model, Plast Reconstr Surg 114, 1802–1814 (2004).PubMedCrossRefGoogle Scholar
  71. 71.
    B. A. Bradley, Rejection and recipient age, Transpl Immunol 10, 125–132 (2002).PubMedCrossRefGoogle Scholar
  72. 72.
    L. R. Raiz, K. M. Kilty, M. L. Henry, and R. M. Ferguson, Medication compliance following renal transplantation, Transplantation 68, 51–55 (1999).PubMedCrossRefGoogle Scholar
  73. 73.
    Z. A. Massy, C. Guijarro, M. R. Wiederkehr, J. Z. Ma, and B. L. Kasiske, Chronic renal allograft rejection: Immunologic and nonimmunologic risk factors, Kidney Int 49, 518–524 (1996).PubMedCrossRefGoogle Scholar
  74. 74.
    B. Kaplan, J. D. Schold, and H. U. Meier-Kriesche, Long-term graft survival with neoral and tacrolimus: A paired kidney analysis, J Am Soc Nephrol 14, 2980–2984 (2003).PubMedCrossRefGoogle Scholar
  75. 75.
    R. Mendez, T. Gonwa, H. C. Yang, S. Weinstein, S. Jensik, and S. Steinberg, A prospective, randomized trial of tacrolimus in combination with sirolimus or mycophenolate mofetil in kidney transplantation: Results at 1 year, Transplantation 80, 303–309 (2005).PubMedCrossRefGoogle Scholar
  76. 76.
    A. Humar, A. Hassoun, R. Kandaswamy, W. D. Payne, D. E. Sutherland, and A. J. Matas, Immunologic factors: The major risk for decreased long-term renal allograft survival, Transplantation 68, 1842–1846 (1999).PubMedCrossRefGoogle Scholar
  77. 77.
    R. J. Knight, L. Burrows, and C. Bodian, The influence of acute rejection on long-term renal allograft survival: A comparison of living and cadaveric donor transplantation, Transplantation 72, 69–76 (2001).PubMedCrossRefGoogle Scholar
  78. 78.
    S. A. Joosten, Y. W. Sijpkens, C. van Kooten, and L. C. Paul, Chronic renal allograft rejection: Pathophysiologic considerations, Kidney Int 68, 1–13 (2005).PubMedCrossRefGoogle Scholar
  79. 79.
    G. Remuzzi, Transplantation tolerance: Facts and future, Transplant Proc 31, 2955–2957 (1999).PubMedCrossRefGoogle Scholar
  80. 80.
    J. K. Cooper, G. A. Patterson, and E. P. Trulock, Results of single and bilateral lung transplantation in 131 consecutive recipients, J Thorac Cardiovasc Surg 107, 460–471 (1994).PubMedGoogle Scholar
  81. 81.
    J. Kanitakis, D. Jullien, P. Petruzzo, C. Frances, A. Claudy, J. Revillard, and J. Dubernard, Immunohistologic studies of the skin of human hand allografts: Our experience with two patients, Transplant Proc 33, 1722 (2001).PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • Thomas H. Tung
    • 1
  1. 1.Division of Plastic and Reconstructive SurgeryWashington University Medical Center, Washington University School of MedicineSt. Louis

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