Hand transplantation: Pertinent data and future outlook

Transplantation of composite tissue allografts, such as a hand, offers imme nse potential in reconstructive surgery. Review of current replantation lit erature suggests the prospect for significant functional return following h and transplant, provided appropriate patient is selected and allograft reje ction is prevented. Experimental studies of limb transplantation in rodents have demonstrated the efficacy of combination therapy using multiple immun osuppressants. However, long-term survival of limb allografts could not be achieved in large animal models without significant drug toxicity. Given th e potential for organ failure, opportunistic infection, and malignancy resu lting from long-term immunosuppression, the risk-benefit ratio for hand tra nsplant must be carefully weighed. Our laboratory has been able to achieve allograft survival with minimum immunosuppression by MHC matching or donor antigen exposure prior to immune maturity in the swine. Future transplantat ion of composite tissue allografts, therefore, may depend upon such modalit ies to induce host tolerance without long-term immunosuppression. (J Hand S urg 1999;24A:906-913. Copyright (C) 1999 by the American Society for Surger y of the Hand.)