Minimizing immunosuppression in hand transplantation.

Gerald Brandacher, W P Andrew Lee, Stefan Schneeberger

Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. brandacher@jhmi.edu

Expert review of clinical immunology 2012 Sep

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Hand transplantation, despite all initial skepticism, has developed from myth to reality over the past decade and has shown highly encouraging immunological and functional outcomes. However, the requirement of life-long, multidrug immunosuppression bearing the risk of serious side effects still remains the limiting factor for widespread clinical application of this novel reconstructive modality. Recent advances in immunosuppressive drug development and the design of novel cell-based therapeutic strategies that take into consideration the unique immunological and biological aspects of vascularized composite allografts have shown favorable results with regard to minimization of immunosuppressive medication and tolerance induction in both translational animal studies and first clinical trials in reconstructive transplantation. This review provides an overview of the current available conventional treatment protocols and novel immunosuppression minimization concepts for hand transplantation, which ultimately could significantly favor the risk-benefit ratio for this life-changing type of transplant.

Citation

Gerald Brandacher, W P Andrew Lee, Stefan Schneeberger. Minimizing immunosuppression in hand transplantation. Expert review of clinical immunology. 2012 Sep;8(7):673-83; quiz 684