Download PDF
Allgemein- und Viszeralchirurgie up2date 2017; 11(06): 621-634
DOI: 10.1055/s-0043-109363
Viszerale Transplantationen
Georg Thieme Verlag KG Stuttgart · New York

Transplantation komplexer Gewebeverbände (Extremitäten und Gesicht)

Johanna Grahammer
,
Stefan Schneeberger
Further Information

Publication History

Publication Date:
30 November 2017 (online)

Also available at
    Permissions and Reprints All articles of this category

Die rekonstruktive Transplantation (RT) gilt als jüngstes Gebiet in der Transplantationsmedizin. Patienten, die nach einem schweren Trauma eine Hand verloren haben und prothetisch nicht zufriedenstellend zu versorgen sind, sowie Patienten, deren schwere Gesichtsverletzungen nicht mit konventionellen Methoden rekonstruierbar sind, können von einer solchen Transplantation profitieren.
Kernaussagen

  • Die rekonstruktive Transplantationsmedizin umfasst Gesichts-, Extremitäten- und in neuester Zeit auch Uterus- und Penistransplantation.

  • Diese Form der Transplantation ist indiziert bei Patienten, die prothetisch nicht zufriedenstellend zu versorgen sind bzw. deren schwere Gesichtsverletzungen nicht mit konventionellen Methoden rekonstruierbar sind.

  • Immunologisch hat die rekonstruktive Transplantation eine Sonderstellung. So hat jeder Gewebetyp des Transplantates unterschiedliche Eigenschaften: Die Immunologie transplantierter Haut und einer vaskularisierten Knochenmarkkomponente sind von besonderer Bedeutung.

  • Neue therapeutische Konzepte zur Induktion von Toleranz bleiben eine Hoffnung für die Zukunft und würden eine breitere Anwendung dieser Technologie erlauben.

Schlüsselwörter

Handtransplantation - Gesichtstransplantation - Abstoßungsreaktion - Immunsuppression
 

  • Literatur

  • 1 Murray J. Organ transplantation (skin, kidney, heart) and the plastic surgeon. Plast Reconstr Surg 1971; 47: 425-431
    CrossrefPubMedGoogle Scholar
  • 2 Dubernard J, Owen E, Lefrancois N. et al. First human hand transplantation. Case report. Transpl Int 2000; 13 (Suppl. 01) S521-S524
    PubMedGoogle Scholar
  • 3 Lantieri L, Meningaud J, Grimbert P. et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet 2008; 372: 639-645
    CrossrefPubMedGoogle Scholar
  • 4 Shores J, Malek V, Lee WP. et al. Outcomes after hand and upper extremity transplantation. J Mater Sci Mater Med 2017; 28: 72
    CrossrefPubMedGoogle Scholar
  • 5 Kumnig M, Jowsey SG, Rumpold G. et al. The psychological assessment of candidates for reconstructive hand transplantation. Transpl Int 2012; 25: 573-585
    CrossrefPubMedGoogle Scholar
  • 6 Wjujek J, Lasek R. Correlation of axonal regeneration and slow component B in two branches of a single axon. J Neurosci 1983; 3: 234-251
    Google Scholar
  • 7 Salminger S, Sturma A, Roche A. et al. Functional and psychosocial outcomes of hand transplantation compared with prosthetic fitting in below-elbow amputees: a multicenter cohort study. PLoS One 2016; 11: e0162507
    CrossrefPubMedGoogle Scholar
  • 8 Schneeberger S, Khalifian S, Brandacher G. Immunosuppression and monitoring of rejection in hand transplantation. Tech Hand Up Extrem Surg 2013; 17: 208
    CrossrefPubMedGoogle Scholar
  • 9 Ojo AO, Held PJ, Port FK. et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003; 349: 931-940
    CrossrefPubMedGoogle Scholar
  • 10 Kasiske B, Snyder J, Gilbertson D. et al. Cancer after kidney transplantation in the United States. Am J Transpl 2004; 4: 905-913
    CrossrefPubMedGoogle Scholar
  • 11 Morelon E, Testelin S, Petruzzo P. et al. Face transplantation with combined hematopoietic stem cell infusion and vascularized bone marrow: first year of follow-up. Transpl Int 2011; 24: 75
    CrossrefPubMedGoogle Scholar
  • 12 Lee WP, Yaremchuk MJ, Pan YC. et al. Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr Surg 1991; 87: 401-411
    CrossrefPubMedGoogle Scholar
  • 13 Clark R. Resident memory T cells in human health and disease. Sci Transl Med 2015; 7: 269rv1
    CrossrefPubMedGoogle Scholar
  • 14 Petruzzo P, Lanzetta M, Dubernard J. et al. The International Registry on hand and composite tissue transplantation. Transplantation 2010; 90: 1590-1594
    CrossrefPubMedGoogle Scholar
  • 15 Weissenbacher A, Hautz T, Zelger B. et al. Antibody-mediated rejection in hand transplantation. Transpl Int 2014; 27: 13-17
    CrossrefGoogle Scholar
  • 16 Kanitakis J, McGregor B, Badet L. et al. Absence of c4d deposition in human composite tissue (hands and face) allograft biopsies: an immunoperoxidase study. Transplantation 2007; 84: 265-267
    CrossrefPubMedGoogle Scholar
  • 17 Hautz T, Zelger B, Brandacher G. et al. Histopathologic characterization of mild rejection (grade I) in skin biopsies of human hand allografts. Transpl Int 2012; 25: 56-63
    CrossrefPubMedGoogle Scholar
  • 18 Chandraker A, Arscott R, Murphy G. et al. The management of antibody-mediated rejection in the first presensitized recipient of a full-face allotransplant. Am J Transplant 2014; 14: 1446-1452
    CrossrefPubMedGoogle Scholar
  • 19 Kaufman C, Ouseph R, Kutz J. et al. Chronic Rejection in reconstructive Transplantation. In: The Science of reconstructive Transplantation. New York: Humana Press; 2013: 163-179
    Google Scholar
  • 20 Lodhi S, Lamb K, Meier-Kriesche H. Solid organ allograft survival improvement in the united states: the ling-term does not mirror the dramatic short-term success. Am J Transpl 2011; 11: 1226-1235
    CrossrefPubMedGoogle Scholar
  • 21 Kaufman C, Ouseph R, Blair B. et al. Graft vasculopathy in clinical hand transplantation. Am J Transpl 2012; 12 (04) 1004-1016
    CrossrefPubMedGoogle Scholar
  • 22 Kanitakis J, Jullien D, Petruzzo P. et al. Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation 2003; 76: 688-693
    CrossrefPubMedGoogle Scholar
  • 23 Haas M, Sis B, Racusen LC. et al. Banff 2013 meeting report: inclusion of c4d-negative antibody-mediated rejection and antibody-associated arterial lesions. Am J Transpl 2014; 14: 272-283
    CrossrefPubMedGoogle Scholar
  • 24 Thaunat O, Louedec L, Graff-Dubois S. et al. Antiangiogenic treatment prevents adventitial constrictive remodeling in graft arteriosclerosis. Transplantation 2008; 85: 281-289
    CrossrefPubMedGoogle Scholar
  • 25 Tilney N. Renal transplantation between identical twins: a review. World J Surg 1986; 10: 381-388
    CrossrefPubMedGoogle Scholar
  • 26 Unadkat J, Schneeberger S, Horibe E. et al. Composite tissue vasculopathy and degeneration following multiple episodes of acute rejection in reconstructive transplantation. Am J Transpl 2010; 10: 251-261
    CrossrefPubMedGoogle Scholar
  • 27 Petruzzo P, Kanitakis J, Testelin S. et al. Clinicopathological findings of chronic rejection in a face grafted patient. Transplantation 2015; 99: 2644-2650
    CrossrefPubMedGoogle Scholar
  • 28 Hautz T, Zelger BG, Weissenbacher A. et al. Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation. Clin Transplant 2013; 27: 81-90
    CrossrefPubMedGoogle Scholar
  • 29 Starzl TE. Back to the future. Transplantation 2005; 79: 1009-1014
    CrossrefPubMedGoogle Scholar
  • 30 Kawai T, Cosimi B, Sachs D. et al. HLA-mismatched renal transplantation without maintenance immunosuppression. N Engl J Med 2008; 358: 353-361
    CrossrefPubMedGoogle Scholar
  • 31 Granger D, Breidenbach W, Pidwell D. et al. Lack of donor hyporesponsiveness and donor chimerism after clinical transplantation of the hand. Transplantation 2002; 74: 1624-1630
    CrossrefPubMedGoogle Scholar
  • 32 Schneeberger S, Gorantla VS, Brandacher G. et al. Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression. Ann Surg 2013; 257: 345-351
    CrossrefPubMedGoogle Scholar
  • 33 Vincenti F, Rostaing L, Grinyo J. et al. Belatacept and long-term outcomes in kidney transplantation. N Engl J Med 2016; 374: 333-343
    CrossrefPubMedGoogle Scholar
  • 34 De Graav GN, Hesselink DA, Dieterich M. et al. Down-regulation of surface CD28 under belatacept treatment: an escape mechanism for antigen-reactive T-cells. PLoS One 2016; 11: e0148604
    CrossrefPubMedGoogle Scholar
  • 35 Brown C, Badie B, Barish M. et al. Tacrolimus to belatacept conversion following hand transplantation: a case report. Am J Transpl 2015; 15: 2250-2255
    CrossrefPubMedGoogle Scholar
  • 36 Cendales LC, Kanitakis J, Schneeberger S. et al. The Banff 2007 working classification of skin-containing composite tissue allograft pathology. Am J Transpl 2007; 8: 1396-1400
    Google Scholar