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Hand transplantation: pertinent data and future outlook.
1Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
The Journal of Hand Surgery
|October 6, 1999
Summary
Hand transplantation holds promise for reconstructive surgery, but preventing allograft rejection is key. Novel methods like MHC matching and donor antigen exposure may induce tolerance, minimizing immunosuppression risks.
Area of Science:
- Transplantation immunology
- Reconstructive surgery
Background:
- Composite tissue allografts, like hand transplants, offer significant reconstructive potential.
- Current immunosuppression strategies face challenges with long-term toxicity and limited large animal model success.
Purpose of the Study:
- To explore methods for achieving allograft survival with reduced immunosuppression in composite tissue transplantation.
- To investigate strategies for inducing host tolerance to allografts.
Main Methods:
- Review of current replantation literature.
- Analysis of experimental limb transplantation studies in rodents and large animal models.
- Laboratory experiments involving MHC matching and donor antigen exposure in swine models.
Main Results:
- Rodent studies show efficacy of combination immunosuppression.
- Large animal models demonstrate significant drug toxicity with long-term allograft survival.
- Successful allograft survival in swine was achieved with minimal immunosuppression via MHC matching or pre-immune donor antigen exposure.
Conclusions:
- Long-term immunosuppression for hand transplantation carries significant risks (organ failure, infection, malignancy).
- Strategies like MHC matching and donor antigen exposure show promise for inducing tolerance and minimizing immunosuppression.
- Future composite tissue allograft transplantation may rely on tolerance-inducing modalities to improve the risk-benefit ratio.