Face Reconstruction
Immuno-Suppressive
Why are immunosuppressants needed?
Rejection is a significant risk in all transplanted tissue. This is because donor tissue is identified as a foreign body by the recipient's immune system resulting in it being attacked. In order to minimise this risk, donors are matched with recipients to provide maximum compatibility but recipients must still be treated with a life-long cocktail of immunosuppressive drugs. These drugs cause immunosuppression and make rejection less likely.
To read more about immunosuppressants and the various drugs used, click here
Current regimes of immunosuppressants used in composite tissue allografts (transplants) All composite tissue allografts have been maintained on standard immunosuppressive regimes. Some of the transplants have been maintained on lower immunosuppressive requirements than renal allografts. The initial performance of these transplants has been better than comparable renal transplant data. Skin antigenicity, which was anticipated to be a problem has not proved to be so in the clinical setting.
The immunosuppression regimen adopted for composite tissue allografts has been reported for single and bilateral hand transplants. A double hand transplant performed in Austria (2000) treated the hand recipient with antithymocyte globulin as induction therapy and tacrolimus, mycophenolate mofetil, and prednisolone as maintenance immunosuppression. Ganciclovir and co-trimoxazole were given prophylactically (as a preventative dose) for cytomegalovirus and Pneumocystis carinii infection (3). To date, 47 patients have received composite tissue allografts including hands, larynx and the wall of the abdomen. 24 hand transplants have been performed in 18 patients. These patients have been shown to benefit both functionally and psychologically. These benefits are greater in patients missing both hands. The very first transplant has been removed at the patient's request due to graft rejection following non-compliance. (The recipient stopped taking his immuno suppressant drugs and asked for the hand to be removed.) This case illustrates the importance of patient selection. (4)
The risks of immunosuppression
Immunosuppression itself is not without risks as the body's defences are reduced rendering the individual more susceptible to infection and disease. In addition, immunosuppressants can lead to side effects in some patients.
To avoid these potential side-effects, current research is focused on replacing our regimes of long term immunosuppression with induced donor tolerance. These treatments rely on the immune system becoming accustomed to the new tissue and therefore ceasing to mount attacks on it. Excitingly, these approaches are being trialled in renal transplantation and with favourable initial results.
1. Lee, W.P., Butler, P, E., Randolph, M.A., and Yaremchuk, M.J. Donor modification leads to prolonged survival of limb allografts. Plast. Reconstr. Surg. 108:1235, 2001.
2. Lee, W.P., Yarumchuk, M.J., Pan. Y.C., Randolph, M.A., Tan, C.M. and Weiland, A.J. Relative antigenicity of components of a vascularized limb allograft. Plast Reconstr. Surg. 87: 401, 1991.
3. Margreiter, R., Brandacher, G. Nickovic, M. Steurer, W. Kreczy, A., Schneeberger, S., A double-hand transplant can be worth the effort! Transplantation, Volume 74(1) 15 July 2002, pp85-90.
4. Dubernard, J.M., Owen, E., Herzberg, G., et al. What is happening with hand transplants? Lancet 357: 1711, 2001.
5. Working Party Report- The Royal College of Surgeons of England: Face Transplantation. 203; 1-24.