ABSTRACT
After announcements of successful hand, larynx, knee, muscle, nerve, and, most recently,
face transplantation, composite tissue allografts (CTAs) have been introduced into
the armamentarium of plastic and reconstructive surgery. Because the microsurgical
techniques required to perform CTA transplants are well established and used in daily
practice by plastic surgeons, the immunologic aspects of transplantation remain of
great interest to plastic surgeons. CTAs offer a unique potential for coverage of
large multitissue defects; however, compared with the relatively homogenous tissue
of solid organ transplants, the heterogenicity of tissue components of CTA may generate
high immunologic responses. Although modern immunosuppressive agents significantly
improve successful allograft acceptance, chronic allograft rejection as well as immunosuppressive
drug toxicity remain major problems in the clinical practice of transplantation. The
major goal of transplantation immunology is to develop tolerance to allograft transplants
and long-term drug-free survival. Several experimental protocols have been designed
to develop tolerance; however, none of them have been proved to induce tolerance in
clinical transplantation. This review outlines the mechanisms of allograft acceptance
and rejection and describes the barriers to transplantation tolerance based on our
current knowledge as it applies to solid organs and CTA transplants. The review also
describes innovative immunosuppressive protocols.
KEYWORDS
Composite tissue allograft - immune response - immunosuppression
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Maria SiemionowM.D. Ph.D. D.Sc.
Department of Plastic Surgery, The Cleveland Clinic
9500 Euclid Avenue, Cleveland, OH 44195
