Composite tissue allotransplantation (CTA) refers to the transplantation of large complex tissues, often including skin, muscle, nerve, tendon, bone and blood vessels from one person to another. CTA holds great promise for the particularly devastating consequences of severe burn and blast injuries. As an example, severe burns can result in complete loss of the face, including eyelids, muscle, nose, and lips. CTA has the ability to restore function, dramatically improve appearance, protect the eyes from blindness and provide a significantly more normal quality of life. To date, more than 40 hand transplants, 3 face transplants and numerous abdominal wall, larynx, trachea, and knee transplants have been performed worldwide. The major challenge in CTA, as in organ transplantation, is to minimize the use of anti-rejection drugs without risking rejection of the transplanted tissue. Anti-rejection drugs have a number of side effects and can put the patient at risk for life-threatening infections, viruses and cancers. Current research to induce “tolerance” for transplanted tissue has great potential to allow transplantation of organs and tissues without the need for drugs.
The potential for drug-free transplantation of tissues for non life-threatening conditions would revolutionize the field of reconstructive surgery. The biggest impact, by far, would be on the transfer of those tissues which impact quality of life. The ability to trick the immune system into accepting transplanted tissues such as skin, knees, hips and shoulders without the need for life-long anti-rejection drugs would benefit many thousands of people in U.S. alone and millions of people worldwide. The maintenance cost of anti-rejection drugs, generally between $15,000 and $40,000 per year, will be dramatically reduced or eliminated when tolerance is achieved.
Military Impact of CTA: According to the American Society of Reconstructive Transplantation (ASRT), CTA will “allow us for the first time to reconstruct extremities and faces, restoring our injured service members and enabling more of them to return to duty and the normal activities of daily living. CTA represents an immediate clinical deliverable for our wounded warriors.”
How Does Stem Cell Research Impact CTA?
Transplanting bone marrow stem cells from the donor simultaneously with CTA may induce a “twin” immune system that will help the body recognize the transplanted tissue as self rather than foreign. The ability to recognize transplanted tissue as self, or tolerance, would dramatically reduce or eliminate the need for anti-rejection drugs following transplantation. Researchers supported by the NFCTR are working on an approach that would allow bone marrow stem cells from the donor to be transplanted without the toxic levels of radiation and chemotherapy currently required for a traditional bone marrow stem cell transplant, even when donor and recipient are poorly matched.
Link to video
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Dr. Suzanne Ildstad |
Professor of Surgery, University of Louisville |
Director, Institute of Cellular Therapeutics |
Jewish Hospital Distinguished Professor of Transplantation |
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Useful / Helpful Links
American Society of Reconstructive Transplantation
www.a-s-r-t.com
National Center for Biotechnology Information – PubMed
www.ncbi.nlm.nih.gov
FDA Consumer Magazine: Keeping Human Tissue Transplants Safe
/www.fda.gov/fdac/features