Transplantation of Composite Tissue Allografts

PRINTED IN THE JULY 2008 ISSUE OF ANNALS OF PLASTIC SURGERY Hewitt CW, Lee WPA, Gordon CR, eds. Transplantation of Composite Tissue Allografts. New York: Springer; 2008, 498 pp, $169.00. Some books are indispensable to their times. Forty years ago, plastic surgeons were redefining many surgical problems and much of their surgical thinking into more rigorous biologic concepts of wound healing. Peacock and Van Winkle published their Surgery and Biology of Wound Repair in 1970,1 and provided the fundamental text for that evolutionary period. I believe that Transplantation of Composite Tissue Allografts is, likewise, an indispensable book for the developing era of reconstructive transplantation. This field should broadly engage reconstructive plastic surgeons. While organ transplantation, though clinically pioneered by Nobel-laureate plastic surgeon Joseph Murray, could readily move into the realm of general surgery technique, composite transplantation of limbs and facial units will necessarily demand the skills of microsurgery, peripheral nerve surgery, and reconstructive surgery provided by plastic surgeons. Plastic surgeons who hope to participate in these developments (or even intelligently follow them) should read this book. The book is a multiauthored text, but it is a competently organized one, with good coordination of contributions and minimal redundancy. Current biologic concepts and clinical application of composite tissue transplantation are presented with detail and intelligent interpretation. The section on immunosuppression and tolerance are excellent summaries of these experimental concepts and current clinical applications. The persistent hazards of immunosuppression and the elusiveness of induced tolerance are honestly summarized. Thorough descriptions of immunosuppressive agents and immunologic strategies are valuable parts of these sections. The clinical summaries of composite tissue transplants to date illustrate the potentials and problems of these procedures. I began reading this volume with the opinion that single hand transplants have been a bad idea so far, with questionable functional outcomes, immunosuppression complications, rejection episodes that could lead to chronic rejection syndromes, and out-right failure associated problems of patient selection and support.2 Reading this book did not change my mind. This reading, however, further impressed me with the utility of the bilateral hand transplant procedures. Careful analysis of transplantation cases as presented in this book will be the invaluable basis for judging clinical results and projecting applications in the future of reconstructive transplantation. I congratulate the editors and authors on the timely and well-executed volume. I recommend it highly. William C. Lineaweaver, MD Editor REFERENCES[http://ovidsp.tx.ovid.com.libproxy2.umdnj.edu/spb/gifs/ftup.gif] 1. Peacock E, Van Winkle W. Surgery and biology of wound repair. Philadelphia: Saunders; 1970. [Context Link] 2. Lineaweaver W. Chronic rejection, hand transplantation, and the monkey's paw (editorial). Microsurgery. 2006;26:419. Bibliographic Links [Context Link]

• Section I.- The Establishment of Composite Tissue Allotransplantion as a Clinical Reality.- The Evolution of Composite Tissue Allotransplantation: the Twentieth Century Realization of “Cosmas and Damian”.- The Impact of the Discovery of Cyclosporine on Transplantation of Composite Tissue Allografts.- The First Limb Transplants with Cyclosporine.- Section II.- Translational Research in Composite Tissue Allotransplantation.- Relative Antigenicity of Allograft Components and Differential Rejection.- On the Road to Tolerance Induction in Composite Tissue Allotransplantation.- Donor-Specific Tolerance.- Immune Tolerance Induction: Basic Concepts for Composite Tissue Allotransplantation.- Section III.- Allograft Survival with Calcineurin Inhibitors.- Long-Term Prevention of Rejection and Combination Drug Therapy.- Locoregional Immunosuppression in Composite Tissue Allografting.- New Approaches to Antibody Therapy.- Section IV.- World Experience of Hand Transplantation-Independent Assessment.- Hand Transplantation: Lyon Experience.- Hand Transplantation: The Louisville Experience.- Hand Transplantation: The Innsbruck Experience.- Section V.- Vascularized Bone Marrow Transplantation.- Vascularized Bone Marrow Transplantation: Pathology of Composite Tissue Transplantation-Induced Graft-Versus-Host-Disease.- Immune Cell Redistribution After Vascularized Bone Marrow Transplantation.- Section VI.- Vascularized Knee Transplantation.- Tracheal Transplantation.- Laryngeal Transplantation.- Face Transplantation.- The Role of Allografts in Lower Extremity Reconstruction.- Skin Allografts in Scalp Reconstruction.- Abdominal Wall Transplantation.- Peripheral Nerve Allotransplantation.- Live-Donor Nerve Transplantation.- Section VII.- Ethical and Policy Concerns of Hand/FaceTransplantation.- Ethical Debate on Human Face Transplantation.- Psychosocial Issues in Composite Tissue Allotransplantation.- Composite Tissue Transplantation in the Twenty-First Century.