Locoregional Immunosuppression in Composite Tissue Allografting
Unlike visceral solid-organ transplants, composite tissue allografts (CTAs) are modules composed of various tissues, each with differing antigenicity, and therefore differing potential for rejection. Skin and muscle (and perhaps synovium) are the most antigenic and appear to be most susceptible to rejection, while bone, tendon, cartilage, and neurovascular tissue appear to be less immunogenic and evoke rejection responses of lower magnitude. Although CTAs have tremendous potential clinical application for functional and structural reconstruction of major congenital and acquired peripheral tissue defects, these transplants have remained one of the last frontiers in clinical organ transplantation because of concerns expressed beginning 15–20 years ago regarding their risk/benefit ratio. Even now, with the performance of unilateral hand, bilateral hand, or digit transplantation in a total of 18 patients from 1998 to 2004, there still remains much concern with regard to the risks of long-term immunosuppression and the potential for development of chronic rejection. The following two questions address the key issues involved. (1) Can rejection of these highly antigenic tissues be prevented using currently available immunosuppressive regimens with acceptable drugspecific and generalized toxicity? (2) Will function be restored to a significant degree so as to justify the surgical and immunosuppressive risks involved?
KeywordsGraft Survival Skin Allograft Fluocinolone Acetonide Cortisone Acetate Composite Tissue
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