Current Status of Composite Tissue Allotransplantation

Abstract

Composite tissue allotransplantation (CTA) is emerging as a potential treatment for complex tissue defects. A major drawback for CTA remains the requirement of lifelong immunosuppression. Up to date numerous experimental CTA models have been introduced to the transplantation literature. After the first hand transplantation in 1998, the clinical applicability of CTA has attracted a lot of attention. This article will outline the historical background of CTA and our experience in different CTA models.

Zusammenfassung

Die Allotransplantation von unterschiedlichen Gewebekomponenten in einem Transplantat (composite tissue allotransplantation, CTA) ist eine sich neu entwickelnde Behandlungsmöglichkeit für komplexe Gewebedefekte. Die Hauptproblematik liegt unverändert in der Notwendigkeit einer lebenslangen Immunosuppression. Eine Vielzahl experimenteller Modelle der CTA wurde bislang publiziert. Nach der ersten allogenen Handtransplantation im Jahre 1998 hat gerade die klinische Anwendung ein großes wissenschaftliches und öffentliches Interesse erfahren. Diese Übersichtsarbeit soll die historische Entwicklung der Allotransplantation von Mehrkomponenten-Transplantaten und unsere eigenen Erfahrungen mit verschiedenen experimentellen Modellen zusammenfassen.

Key words

experimental transplantation - experimental surgery - composite tissue allotransplantation - CTA

Schlüsselwörter

Transplantation - experimentelle Chirurgie - Mehrkomponenten‐Transplantate - CTA

References

• 1 Agaoglu G, Siemionow M. Combined semimembranosus muscle and epigastric skin flap: a new model of composite-free flap in the rat.  Ann Plast Surg. 2005;  55 310-315
• 2 Agaoglu G, Unal S, Siemionow M. Transplantation of the vascularized bone allograft into the inguinal region.  Plast Reconstr Surg. 2005;  115 1794-1795
• 3 Agaoglu G, Carnevale K A, Zins J E, Siemionow M. Bilateral vascularized femoral bone transplant: a new model of vascularized bone marrow transplantation in rats, Part I.  Ann Plast Surg. 2006;  56 658-664
• 4 Akst L M, Siemionow M, Dan O. et al. . Induction of tolerance in a rat model of laryngeal transplantation.  Transplantation. 2003;  76 1763-1770
• 5 Altman L K. French, in first, use a transplant to repair a face.  NY Times (Print). 2005;  A1-A6
• 6 Arai K, Hotokebuchi T, Miyahara H. et al. . Limb allografts in rats immunosuppressed with FK506. I. Reversal of rejection and indefinite survival.  Transplantation. 1989;  48 782-786
• 7 Benhaim P, Anthony J P, Ferreira L. et al. . Use of combination of low-dose cyclosporine and RS-61443 in a rat hindlimb model of composite tissue allotransplantation.  Transplantation. 1996;  61 527-532
• 8 Birchall M. Tongue transplantation.  Lancet. 2004;  363 1663
• 9 Black K S, Hewitt C W, Fraser L A. et al. . Cosmas and Damian in the laboratory.  N Engl J Med. 1982;  306 368-369
• 10 Black K S, Hewitt C W, Fraser L A. et al. . Composite tissue (limb) allografts in rats. II. Indefinite survival using low-dose cyclosporine.  Transplantation. 1985;  39 365-378
• 11 Borel J F, Feurer C, Gubler H U, Stahelin H. Biological effects of cyclosporine A: A new antilymphocytic agent.  Agents Actions. 1976;  6 (Suppl) 468-475
• 12 Butler P E, Clarke A, Hettiaratchy S. Facial transplantation.  BMJ. 2005;  331 1349-1350
• 13 Buttemeyer R, Jones N F, Min Z. et al. . Rejection of the component tissues of limb allografts in rats immunosuppressed with FK‐506 and cyclosporine.  Plast Reconstr Surg. 1996;  97 139-148 149-151
• 14 Cendales L, Breidenbach W, Granger D K. Evaluation of function following human hand transplantation.  Transplantation. 2000;  69 S295
• 15 Daniel R K, Egerszegi E P, Samulack D D. et al. . Tissue transplants in primates for upper extremity reconstruction: a preliminary report.  J Hand Surg [Am]. 1986;  11 1-8
• 16 Demir Y, Ozmen S, Klimczak A. et al. . Tolerance induction in composite facial allograft transplantation in the rat model.  Plast Reconstr Surg. 2004;  114 1790-1801
• 17 Demir Y, Ozmen S, Klimczak A. et al. . Strategies to develop chimerism in vascularized skin allografts across MHC barrier.  Microsurgery. 2005;  25 415-422
• 18 Devauchelle B, Badet L, Lengele B. et al. . First human face allograft: early report.  Lancet. 2006;  368 203-209
• 19 Dubernard J M, Owen E, Herzberg G. et al. . Human hand allograft: report on first 6 months.  Lancet. 1999;  353 1315-1320
• 20 Editorial. The first facial transplant.  Lancet. 2005;  366 1984
• 21 Francois C G, Breidenbach W C, Maldonado C. et al. . Hand transplantation: comparisons and observations of the first four clinical cases.  Microsurgery. 2000;  20 360-371
• 22 Gold M E, Randzio J, Kniha H. et al. . Transplantation of vascularized composite mandibular allografts in young cynomolgus monkeys.  Ann Plast Surg. 1991;  26 125-132
• 23 Guimberteau J C, Baudet J, Panconi B, Boileau R, Potaux L. Human allotransplant of a digital flexion system vascularized on the ulnar side pedicle: a preliminary report and 1-year follow-up of two cases.  Plast Reconstr Surg. 1992;  89 1135-1147
• 24 Hettiaratchy S, Randolph M A, Petit F. et al. . Composite tissue allotransplantation - a new era in plastic surgery?.  Br J Plast Surg. 2004;  57 381-391
• 25 Hewitt C W, Black K S, Fraser L A. et al. . Composite tissue (limb) allografts in rats. I. Dose-dependent increase in survival with cyclosporine.  Transplantation. 1985;  39 360-364
• 26 Hewitt C W, Ramsamooj R, Patel M P. et al. . Development of stable mixed T cell chimerism and transplantation tolerance without immune modulation in recipients of vascularized bone marrow allografts.  Transplantation. 1990;  50 766-772
• 27 Hofmann G O, Kirschner M H, Wagner F D, Brauns L, Gonschorek O, Bühren V. Allogeneic vascularized grafting of human knee joints under postoperative immunosuppression of the recipient.  World J Surg. 1998;  22 818-823
• 28 Hofmann G O, Kirschner M H, Wagner F D. et al. . Allogeneic vascularized transplantation of human femoral diaphyses and total knee joints - first clinical experiences.  Transplant Proc. 1998;  30 2754-2761
• 29 Hofmann G O, Kirschner M H. Clinical experience in allogeneic vascularized bone and joint allografting.  Microsurgery. 2000;  20 375-383
• 30 Hu W, Lu J, Zhang L. et al. . A preliminary report of penile transplantation.  Eur Urol. 2006;  50 851-853
• 31 Ildstad S T, Wren S M, Bluestone J A, Barbieri S A, Stephany D, Sachs D H. Effect of selective T cell depletion of host and/or donor bone marrow on lymphopoietic repopulation, tolerance, and graft-vs-host disease in mixed allogeneic chimeras (B10 + B10.D2-B10).  Immunology. 1986;  136 28-33
• 32 Inceoglu S, Siemionow M, Chick L. et al. . The effect of combined immunosuppression with systemic low-dose cyclosporin and topical fluocinolone acetonide on the survival of rat hind-limb allografts.  Ann Plast Surg. 1994;  33 57-65
• 33 Jensen J N, Mackinnon S E. Composite tissue allotransplantation: a comprehensive review of the literature - part 1.  J Reconstr Microsurg. 2000;  16 57-68
• 34 Jesitus J. Chinese transplant surgery.  Cosmetic Surgery Times. 2006;  9 12-14
• 35 Jones Jr J W, Ustuner E T, Zdichavsky M. et al. . Long-term survival of an extremity composite tissue allograft with FK506-mycophenolate mofetil therapy.  Surgery. 1999;  126 384-388
• 36 Jones J W, Gruber S A, Barker J H. et al. . Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team.  N Engl J Med. 2000;  343 468-473
• 37 Jones T R, Humphrey P A, Brennan D C. Transplantation of vascularized allogeneic skeletal muscle for scalp reconstruction in renal transplant patient.  Transplant Proc. 1998;  30 2746-2753
• 38 Klimczak A, Agaoglu G, Carnevale K A, Siemionow M. Applications of bilateral vascularized femoral bone marrow transplantation for chimerism induction across the major histocompatibility (MHC) barrier: Part II.  Ann Plast Surg. 2006;  57 422-430
• 39 Kulahci Y, Molski M, Siemionow M. Development of the alternative composite tissue allograft transplantation models for reconstruction of the head and neck defects. Paper presented at 51st Annual Meeting of the Plastic Surgery Research Council, May 17 - 20, 2006, Dana Point, California. 
• 40 Kulahci Y, Klimczak A, Siemionow M. A new composite tissue allograft transplantation model for reconstruction of the head and neck defects and long term survival permitted by donor specific chimerism under low dose cyclosporine A treatment. Paper presented at 23rd Annual Meeting of the ASRM, January 13 - 16, 2007, Puerto Rico. 
• 41 Lee W P, Yaremchuk M J, Pan Y C, Randolph M A, Tan C M, Weiland A J. Relative antigenicity of components of a vascularized limb allograft.  Plast Reconstr Surg. 1991;  87 401-411
• 42 Lee W P, Rubin J P, Cober S. et al. . Use of swine model in transplantation of vascularized skeletal tissue allografts.  Transplant Proc. 1998;  30 2743-2745
• 43 Levi D M, Tzakis A G, Kato T. et al. . Transplantation of the abdominal wall.  Lancet. 2003;  36 2173-2176
• 44 Lorenz R R, Fritz M A, Strome M. Special feature: current state of laryngeal transplantation.  Curr Opin Otolaryngol Head Neck Surg. 2001;  9 381-386
• 45 Lorenz R R, Dan O, Fritz M A. et al. . Rat laryngeal transplant model: technical advancements and a redefined rejection grading system.  Ann Otol Rhinol Laryngol. 2002;  111 1120-1127
• 46 Lukomska B, Durlik M, Pienkowska B. et al. . Transplantation of bone marrow with vascularized bone.  Transplant Proc. 1990;  22 2255-2256
• 47 Mackinnon S E, Hudson A R, Bain J R, Falk R E, Hunter D A. The peripheral nerve allograft: an assessment of regeneration in the immunosuppressed host.  Plast Reconstr Surg. 1987;  79 436-446
• 48 Mackinnon S E, Doolabh V B, Novak C B. et al. . Clinical outcome following nerve allograft transplantation.  Plast Reconstr Surg. 2001;  107 1419-1429
• 49 Muramatsu K, Doi K, Kawai S. Limb allotransplantation in rats: combined immunosuppression by FK‐506 and 15-deoxyspergualin.  J Hand Surg [Am]. 1999;  24 586-593
• 50 Ozer K, Siemionow M. Combination of anti-ICAM‐1 and anti-LFA‐1 monoclonal antibody therapy prolongs allograft survival in rat hind-limb transplants.  J Reconstr Microsurg. 2001;  17 511-517
• 51 Ozer K, Gurunluoglu R, Zielinski M. et al. . Extension of composite tissue allograft survival across major histocompatibility barrier under short course of anti-lymphocyte serum and cyclosporine A therapy.  J Reconstr Microsurg. 2003;  19 249-256
• 52 Ozer K, Zielinski M, Siemionow M. New composite tissue allograft transplantation model in mouse with intravital microscopic evaluation of microcirculation.  J Reconstr Microsurg. 2003;  19 323-330
• 53 Ozer K, Oke R, Gurunluoglu R. et al. . Induction of tolerance to hind limb allografts in rats receiving cyclosporine A and antilymphocyte serum: effect of duration of the treatment.  Transplantation. 2003;  75 31-36
• 54 Ozer K, Izycki D, Zielinski M. et al. . Development of donor-specific chimerism and tolerance in composite tissue allografts under alpha,beta-T-cell receptor monoclonal antibody and cyclosporine A treatment protocols.  Microsurgery. 2004;  24 248-254
• 55 Ozmen S, Ulusal B G, Ulusal A E. et al. . Composite vascularized skin/bone transplantation models for bone marrow-based tolerance studies.  Ann Plast Surg. 2006;  56 295-300
• 56 Petit F, Minns A B, Dubernard J M. et al. . Composite tissue allotransplantation and reconstructive surgery: first clinical applications.  Ann Surg. 2003;  237 19-25
• 57 Press B H, Sibley R K, Shons A R. Limb allotransplantation in the rat: extended survival and return of nerve function with continuous cyclosporine/prednisone immunosuppression.  Ann Plast Surg. 1986;  16 313-321
• 58 Siemionow M, Ozer K. Advances in composite tissue allograft transplantation as related to the hand and upper extremity.  J Hand Surg [Am]. 2002;  27 565-580
• 59 Siemionow M, Oke R, Ozer K. et al. . Induction of donor-specific tolerance in rat hind-limb allografts under antilymphocyte serum and cyclosporine A protocol.  J Hand Surg [Am]. 2002;  27 1095-1103
• 60 Siemionow M, Gozel-Ulusal B, Engin Ulusal A. et al. . Functional tolerance following face transplantation in the rat.  Transplantation. 2003;  75 1607-1609
• 61 Siemionow M Z, Izycki D M, Zielinski M. Donor-specific tolerance in fully major histocompatibility complex-mismatched limb allograft transplants under an anti-alphabeta T-cell receptor monoclonal antibody and cyclosporine A protocol.  Transplantation. 2003;  76 1662-1668
• 62 Siemionow M, Ulusal B G, Ozmen S. et al. . Composite vascularized skin/bone graft model: a viable source for vascularized bone marrow transplantation.  Microsurgery. 2004;  24 200-206
• 63 Siemionow M, Klimczak A, Unal S. Different routes of donor derived hematopoietic stem cells transplantation for donor specific chimerism induction across MHC barrier. Paper presented at XX International Congress of The Transplantation Society, Vienna. 2004
• 64 Siemionow M Z, Klimczak A, Unal S. Different routes of donor-derived hematopoietic stem cell transplantation for donor-specific chimerism induction across MHC barrier.  Transplant Proc. 2005;  37 62-64
• 65 Siemionow M, Ozer K, Izycki D. et al. . A new method of bone marrow transplantation leads to extension of skin allograft survival.  Transplant Proc. 2005;  37 2309-2314
• 66 Siemionow M, Izycki D, Ozer K. et al. . Role of thymus in operational tolerance induction in limb allograft transplant model.  Transplantation. 2006;  81 1568-1576
• 67 Spurgeon B. Surgeons pleased with patient's progress after face transplant.  BMJ. 2005;  331 1359
• 68 Stark G B, Swartz W M, Narayanan K. et al. . Hand transplantation in baboons.  Transplant Proc. 1987;  19 3968-3971
• 69 Starzl T E, Demetris A J, Murase N, Ildstad S, Ricordi C, Trucco M. Cell migration, chimerism, and graft acceptance.  Lancet. 1992;  339 1579-1582
• 70 Stevens H P, Hovius S E, Vuzevski V D. et al. . Immunological aspects of allogeneic partial hand transplantation in the rhesus monkey.  Transplant Proc. 1990;  22 2006-2008
• 71 Strome S, Sloman-Moll E, Samonte B R. et al. . Rat model for a vascularized laryngeal allograft.  Ann Otol Rhinol Laryngol. 1992;  101 950-953
• 72 Strome M, Stein I, Esclamado R. et al. . Laryngeal transplantation and 40-month follow-up.  N Engl J Med. 2001;  344 1676-1679
• 73 Ulusal B G, Ulusal A E, Ozmen S. et al. . A new composite facial and scalp transplantation model in rats.  Plast Reconstr Surg. 2003;  112 1302-1311
• 74 Unal S, Agaoglu G, Zins J. et al. . New surgical approach in facial transplantation extends survival of allograft recipients.  Ann Plast Surg. 2005;  55 297-303
• 75 Ustuner E T, Zdichavsky M, Ren X. et al. . Long-term composite tissue allograft survival in a porcine model with cyclosporine/mycophenolate mofetil therapy.  Transplantation. 1998;  66 1581-1587
• 76 Yazici I, Unal S, Siemionow M. Composite hemiface/calvaria transplantation model in rats.  Plast Reconstr Surg. 2006;  118 1321-1327
• 77 Yazici I, Carnevale K, Klimczak A, Siemionow M. A new rat model of maxilla allotransplantation.  Ann Plast Surg. 2007;  58 338-344