Logo Annals of Transplantation Logo Annals of Transplantation Logo Annals of Transplantation

21 May 2009

Immunosuppression for composite tissue transplantations

B D Kahan

Ann Transplant 2009; 14(1): 20-20 :: ID: 880271

Abstract

Composite tissue transplantation refers to the grafting of skin, subcutaneous
tissue, muscle tendons, nerves, vascular tissues and bone generally to replace
injuries. On the one hand, these grafts do not provide or extend life as is the case for organ transplants. Thus, the threshold for adverse sequelae of immunosuppressive therapy is far lower than that for vital transplantations. In particular susceptibility to end organ toxicity, opportunistic infections and
increased risk of neoplasms represents appreciable risk to quality of life and
possibly survival. On the other hand, the composite mass represents a large
antigenic load with skin being the most immunogenic tissue. However, bone
marrow is a source of hematolymphopoietic stem cells which in experimental animals serve as vectors of alloacceptance or of chimerism. As low as 1%  donor chimerism of the hybrid immune system might produce bidirectional donor: host tolerance. In the report by Granger, peripheral microchimerism
occurred only transiently in hand transplantation. Furthermore, the risk of graft versus host disease must be balanced against the emergence of CD8+/ TCR facilitating cells as described by Ilstad to induce tolerogenic regulatory T cells which have the CD4+/CD25+ high/Fox P3/CCR4/CLA/CCR6 phenotype as described by Hirahara. The latter state is more likely to emerge following nonmyeloablative recipient conditioning with 2000cGyTBI combined with fludarabine and immunosuppression. Whereas triple immunosuppression has been widely employed for this purpose, induction with alemtuzumab has been followed by dual maintenance therapy with tacrolimus plus mycophenolate mofetil or tacrolimus plus prednisone in recent cases. The roles of agents blocking adhesion molecules or of adjunctive cutaneous drug application remain under active investigation.

Keywords:

Comments

In Press

06 May 2022 : Original article  

Phosphatidylethanol (PEth) for Monitoring Sobriety in Liver Transplant Candidates: Preliminary Results of D...

Ann Transplant In Press; DOI: 10.12659/AOT.936293  

Most Viewed Current Articles

26 Jan 2022 : Review article  

Recurrence of Hepatocellular Carcinoma After Liver Transplantation: Risk Factors and Predictive Models

DOI :10.12659/AOT.934924

Ann Transplant 2022; 27:e934924

29 Dec 2021 : Original article  

Efficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...

DOI :10.12659/AOT.933588

Ann Transplant 2021; 26:e933588

24 Jul 2020 : Review article  

Kidney Transplantation in the Times of COVID-19 – A Literature Review

DOI :10.12659/AOT.925755

Ann Transplant 2020; 25:e925755

15 Mar 2022 : Case report  

Combined Liver, Pancreas-Duodenum, and Kidney Transplantation for Patients with Hepatitis B Cirrhosis, Urem...

DOI :10.12659/AOT.935860

Ann Transplant 2022; 27:e935860

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358