Composite Tissue Allotransplantation (CTA): Current Status and Future Insights

Approximately 7 million individuals (over 1 million amputees) require complex reconstructive procedures in the United States each year. The recent success of clinical composite tissue allotransplantation, attests to the fact that composite tissue allografts have tremendous potential in these life-enhancing reconstructions. This review summarizes the initial outcomes of the first four human hand transplants, together with those of the first larynx, bone, knee, nerve and tendon transplants, with special emphasis on the operative technique, graft survival and functional outcomes. The May 2000 Louisville symposium, where these results were presented was undoubtedly a milestone in the history of modern composite tissue allotransplantation. It set the stage for reconstructive and transplant surgeons, researchers, physiotherapists, patients and patient advocates and members of the community to convene and discuss major advances in current composite tissue allotransplantation. The symposium underscored the vital importance of objective evaluation of the status of composite tissue allotransplantation by frank dissemination of details of clinical results and complications of the transplants performed thus far. The composite tissue allotransplantation area is among the newest of transplant areas. The immunology of composite tissue allografts is complex, making tolerance more difficult to achieve than organ tolerance. It needs to be emphasized that any episodes of acute rejection should be prevented for perfect restoration of function and to minimize the risk of chronic rejection in composite tissue allografts. Efficacious, safe and ethical clinical tolerance protocols could improve patient acceptance of composite tissue allografts by providing an alternative to chronic immunosuppression.