Chapter category: Transplant
T-Cell Depletion Strategies for Tolerance Induction: Potential Application in Composite Tissue Transplantation
Hand Transplantation
Edited by: Vijay S. Gorantla and Warren C. BreidenbachISBN: TBA
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Chapter authors:
Erik Schadde and Stuart J. Knechtle
The clinical experience with immunosuppression in composite tissue allografts (CTA) is still small compared with the experience in solid organ transplantation. By 1998 and 2005, 24 hands have been transplanted into 18 recipients.1 The documented experience with immunosuppression in CTA other than hand is also limited. Various immunosuppression protocols were used in the early postoperative phase with most of them including tacrolimus, MMF and steroids.2 Additionally local immunosuppression has been used. Both were based on proof of efficacy in large animal models3,4 as well as on extrapolation from the experience in solid organ transplantation. Most protocols also included induction therapy with either IL-2-receptor antibodies (5 cases) or leukocyte depleting antibodies (11 cases). Induction therapy with depleting antibodies like Thymoglobulin or Campath-1H, more common in heart, kidney and pancreas transplantation than in liver transplantation, is controversial and by most centers mostly given for high risk situations. Clinicians in support of induction therapy argue that it provides more profound immunosuppression, lower rates of acute rejection, and potentially even tolerance.
Additional chapters from this book:
Assessment and Management of Rejection in Hand Transplantation
Stefan Schneeberger and Raimund Margreiter
In 18 hand transplant recipients, 25 rejection episodes have been observed within the first year and two hands have been lost due to rejection. Acute rejection therefore represents the major thr...
Psychological Considerations in Hand Transplantation
Martin M. Klapheke
Psychiatric consultation can play an important role in the assessment of candidates for solid organ transplantation.1 It can be even more critical in the assessment and manage- ment of patients w...
T-Cell Depletion Strategies for Tolerance Induction: Potential Application in Composite Tissue Transplantation
Erik Schadde and Stuart J. Knechtle
The clinical experience with immunosuppression in composite tissue allografts (CTA) is still small compared with the experience in solid organ transplantation. By 1998 and 2005, 24 hands have be...
Perspectives on Chronic Rejection after Hand Transplantation
Vijay S. Gorantla, Carolyn D. Burns and Warren C. Breidenbach
World experience has shown us that acute rejection after hand transplantation is immunologically similar to that in solid organ transplants. The risks of chronic rejection are real after hand tr...
Ethical Criteria for Evaluating Hand Transplantation
Mark A. Rothstein and Heather Hinds
Abuses in biomedical research involving human subjects provided a major impetus to establish the field of interdisciplinary, critical inquiry now known as bioethics,1 and regulation of research re...
Decision Analysis in Hand Transplantation
Stephen E. Edgell
Hand transplantation, as with all medical procedures, provides to the patient the possibility of an improved life along with risks. A decision to have or to not have a hand transplant is one t...
The Evolution and History of Hand Transplantation and Current Status of Composite Tissue Allotransplantation
Chad R. Gordon and Charles W. Hewitt
Composite tissue allotransplantation (CTA) involves “transplanting a graft, composed of a variety of heterogeneous antigenic tissues, across a genetic mismatch,” as in the case of a hand (i....
Rationale for Hand Transplantation
Justin M. Sacks and W.P. Andrew Lee
Hand transplantation is a clinical reality that offers immense reconstructive potential. Benefits of human hand allografts based on reviews of replantation literature are fa- vorable for significan...
