Immunologic considerations in composite tissue transplantation: Overview

Successful clinical transplantation of the upper extremity has been perform ed in several centers. In contrast with the recipients of other immediately vascularized organ allografts, the candidate for upper extremity transplan tation has been, at least during the initial effort, a healthy patient. Alt hough it is clear that composite tissue transplantation (CTA) is a form of allografting that behaves in many ways similarly to immediately vascularize d organ allografts, the issue of developing immunologic understanding of su ch new allografts, awaits greater clinical experience. A summary of the imm unosuppressive management of the patients who received hand allografts, wit h a view to explore the immunologic advantages and disadvantages as well as graft toxicity of the commonly used agents, is reported. This brief overvi ew of the immunologic considerations in CTA is presented with the purpose o f summarizing the main issues that contribute to the ultimate goal of achie ving tolerance. These considerations include (1) the recipients before tran splantation, (2) the donors including possible pretreatment, (3) immunosupp ression for induction, maintenance, and treatment of acute rejection and it s diagnosis, and (4) future potential for tolerance induction. (C) 2000 Wil ey-Liss. Inc.