Abstract
Successful hand and face transplantation in the last decade has firmly established the field of vascularized composite allotransplantation (VCA). The experience in VCA has thus far been very similar to solid organ transplantation in terms of the morbidity associated with long-term immunosuppression. The unique immunological features of VCA such as split tolerance and resistance to chronic rejection are being investigated. Simultaneously there has been laboratory work studying tolerogenic protocols in animal VCA models. In order to optimize VCA outcomes, translational studies are needed to develop less toxic immunosuppression and possibly achieve donor-specific tolerance. This article reviews the immunology, animal models, mixed chimerism & tolerance induction in VCA and the direction of future research to enable better understanding and wider application of VCA.
Highlights
Two areas of transplantation that posed significant obstacles to clinical application were vascularized composite allotransplantation (VCA) and donor-specific tolerance
In the report of the international registry on hand and composite tissue transplantation [6], protective sensibility was restored in 100% patients, tactile sensibility in 90%, and discriminative ability in 84%
As new functional units such as tongue and lacrimal gland are added to the facial allograft, these outcomes are likely to improve even more
Summary
Two areas of transplantation that posed significant obstacles to clinical application were vascularized composite allotransplantation (VCA) and donor-specific tolerance. VCA has achieved acceptance in the field of transplantation [1] and promises to grow exponentially in the few years. In the last 5 years there have been prospective investigational studies of donor bone-marrow infusion in living donor renal transplant recipients which have successfully induced donor-specific tolerance [2,3,4,5]. This new development has the potential for a wider application
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