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Plastic and Reconstructive Surgery Jun 2021After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two... (Review)
Review
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Appreciate the evolution and increasing complexity of transplanted facial allografts over the past two decades. 2. Discuss indications and contraindications for facial transplantation, and donor and recipient selection criteria and considerations. 3. Discuss logistical, immunologic, and cost considerations in facial transplantation, in addition to emerging technologies used. 4. Understand surgical approaches and anatomical and technical nuances of the procedure. 5. Describe aesthetic, functional, and psychosocial outcomes of facial transplantation reported to date.
SUMMARY
This CME article highlights principles and evolving concepts in facial transplantation. The field has witnessed significant advances over the past two decades, with more than 40 face transplants reported to date. The procedure now occupies the highest rung on the reconstructive ladder for patients with extensive facial disfigurement who are not amenable to autologous reconstructive approaches, in pursuit of optimal functional and aesthetic outcomes. Indications, contraindications, and donor and recipient considerations for the procedure are discussed. The authors also review logistical, immunologic, and cost considerations of facial transplantation. Surgical approaches to allograft procurement and transplantation, in addition to technical and anatomical nuances of the procedure, are provided. Finally, the authors review aesthetic, functional, and psychosocial outcomes that have been reported to date.
Topics: Donor Selection; Esthetics; Face; Facial Injuries; Facial Transplantation; Graft Rejection; History, 21st Century; Humans; Imaging, Three-Dimensional; Models, Anatomic; Patient Care Planning; Printing, Three-Dimensional; Transplantation, Homologous; Treatment Outcome
PubMed: 34019516
DOI: 10.1097/PRS.0000000000007932 -
Blood Dec 2010The use of allogeneic hematopoietic cell transplantation (HCT) has expanded progressively, facilitated by the increasing availability of unrelated donors and cord blood,... (Review)
Review
The use of allogeneic hematopoietic cell transplantation (HCT) has expanded progressively, facilitated by the increasing availability of unrelated donors and cord blood, and the inclusion of older patients as transplantation candidates. Indications remain diagnosis-dependent. As novel nontransplantation modalities have been developed concurrently, many patients come to HCT only when no longer responding to such therapy. However, patients with refractory or advanced disease frequently relapse after HCT, even with high-dose conditioning, and more so with reduced-intensity regimens as used for patients of older age or with comorbid conditions. Thus, patients with high-risk malignancies who have substantial comorbidities or are of advanced age are at high risk of both relapse and nonrelapse mortality and should probably not be transplanted. Being in remission or at least having shown responsiveness to pre-HCT therapy is generally associated with increased transplantation success. In addition, to handle the stress associated with HCT, patients need a good social support system and a secure financial net. They must be well informed, not only about the transplantation process, but also about expected or potential post-HCT events, including graft-versus-host disease and delayed effects that may become manifest only years after HCT.
Topics: Adult; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Lymphoproliferative Disorders; Transplantation, Homologous
PubMed: 20702782
DOI: 10.1182/blood-2010-07-259358 -
Transplantation Proceedings Mar 2009
Topics: Congresses as Topic; Facial Transplantation; Hand Transplantation; Humans; Immunosuppressive Agents; Plastic Surgery Procedures; Transplantation; Transplantation, Homologous
PubMed: 19328903
DOI: 10.1016/j.transproceed.2009.02.038 -
Annual Review of Medicine 1977
Review
Topics: Adrenal Cortex Hormones; Antibodies; Antigen-Antibody Complex; Corneal Transplantation; Endothelium; Graft Rejection; History, 19th Century; History, 20th Century; Humans; Postoperative Care; Suture Techniques; Tissue Preservation; Transplantation, Homologous; Vitreous Body; Wound Healing
PubMed: 324359
DOI: 10.1146/annurev.me.28.020177.000321 -
Asian Journal of Andrology Nov 2010This article provides an overview of the ethical issues associated with penile transplantation, a form of composite tissue allografting. There is only one reported case... (Review)
Review
This article provides an overview of the ethical issues associated with penile transplantation, a form of composite tissue allografting. There is only one reported case of human penile transplantation, and, as such, this technique is considered to be experimental. The ethical issues at stake involve both the graft donor and the graft recipient. With regard to the recipient, there are significant concerns relating to surgical risks and benefits, informed consent, body image (including surgical expectations and outcomes) and compliance. Donor issues may include family consent and privacy, as well as graft harvesting (leaving the donor cadaver without a penis). Many of these ethical issues can be explored during the recipient's assessment and consent process. Because no medium-term or long-term outcome data for this procedure exist-only one such operation has ever been performed-the burdens and ethical issues concerning penile transplantation remain unknown.
Topics: Humans; Informed Consent; Male; Penis; Privacy; Replantation; Tissue Donors; Transplantation, Homologous; Penile Transplantation
PubMed: 20835258
DOI: 10.1038/aja.2010.88 -
International Journal of Surgery... May 2017Transplanting a head and brain is perhaps the final frontier of organ transplantation. The goal of body-to-head transplantation (BHT) is to sustain the life of... (Review)
Review
Transplanting a head and brain is perhaps the final frontier of organ transplantation. The goal of body-to-head transplantation (BHT) is to sustain the life of individuals who suffer from terminal disease, but whose head and brain are healthy. Ideally BHT could provide a lifesaving treatment for several conditions where none currently exists. BHT is no ordinary experiment, to transfer a head to another body involves extraordinarily complex medical challenges as well as ethical and existential dilemmas that were previously confined to the imagination of writers of fiction. The possibility of replacing an incurably ill body with a healthy one tests not only our surgical limits, but also the social and psychological boundaries of physical life and alters what we recognize life to be. The purpose of this target article, the complementary manuscript focused on immunological issues in BHT, and the accompanying Commentaries by scholars and practitioners in medicine, immunology, and bioethics is to review major surgical and psychosocial-ethical and immunological considerations surrounding body-to-head transplantation. We hope that together these ideas will provide readers with a comprehensive overview of the possibilities and challenges associated with BHT and initiate professional discussion and debate through which this new frontier in medicine is considered and approached.
Topics: Brain Tissue Transplantation; Head; Human Body; Humans; Organ Transplantation; Transplantation, Homologous
PubMed: 28110028
DOI: 10.1016/j.ijsu.2017.01.077 -
Best Practice & Research. Clinical... Dec 2001Over the past 9 years there has been a remarkable increase in the use of peripheral blood stem cells (PBSC) for allogeneic transplantation, primarily for matched sibling... (Review)
Review
Over the past 9 years there has been a remarkable increase in the use of peripheral blood stem cells (PBSC) for allogeneic transplantation, primarily for matched sibling transplants but also increasingly for unrelated donor transplantation. In 1999 over 50% of all sibling transplants and over 25% of unrelated donor transplants reported to the European Group for Blood and Marrow Transplantation (EBMT) used PBSC. The major reason for this increasing use of PBSC relates to the rapid haemopoietic recovery seen which mirrors the advantages of using PBSC in autologous transplantation. This improvement in engraftment is a consequence of the larger number of stem cells that can be collected from G-CSF-mobilized peripheral blood compared to bone marrow. Evidence from randomized trials now shows a survival advantage for the use of PBSC in patients with advanced leukaemia. The reason for this improved survival appears primarily to relate to a reduced risk of transplant-related mortality and, possibly, a reduced risk of relapse, However, these randomized studies have also confirmed that there is an increased risk of chronic graft-versus-host disease associated with PBSC transplantation and further follow-up is required to determine the long-term impact on outcome.
Topics: Blood Cells; Hematopoietic Stem Cell Mobilization; Humans; Leukemia; Stem Cell Transplantation; Transplantation Immunology; Transplantation, Homologous; Treatment Outcome
PubMed: 11924916
DOI: 10.1053/beha.2001.0167 -
Transplant International : Official... Jun 2016
Topics: Blood Vessels; Facial Transplantation; Hand Transplantation; Humans; Immune System; Neovascularization, Physiologic; Tissue Transplantation; Transplantation, Homologous; United States; Vascularized Composite Allotransplantation; Waiting Lists
PubMed: 27295969
DOI: 10.1111/tri.12792 -
Best Practice & Research. Clinical... 2020Chronic renal failure after liver transplantation (LT) is significantly more frequent than after lung or heart transplantation and it results in an increased short and... (Review)
Review
Chronic renal failure after liver transplantation (LT) is significantly more frequent than after lung or heart transplantation and it results in an increased short and long-term mortality. Renal impairment may occur before LT (functional or due to preexisting parenchymal kidney disease), in the peri-operative period or later after LT. The number of patients with renal failure after LT has increased due to the liver allocation based on MELD and to the more liberal use of higher risk grafts. Calcineurin inhibitor (CNI) nephrotoxicity is the most important cause of renal dysfunction but is a modifiable factor. Strategy to prevent CNI-associated nephrotoxicity is post-op CNI minimization by induction therapy and reduced dose and/or delayed introduction of CNI in combination with mycophenolate mofetil (MMF) or everolimus with no penalty in term of rejection. With everolimus, usually started one month after LT, a drastic minimization of CNI is possible and this results in superior kidney function until at least 3 years follow up. At the moment of renal impairment a drastic reduction of CNI dose together with the introduction of MMF results in an improvement in GFR at 6 to 2 years with a low rate of acute rejection. However, secondary prevention fails to normalize renal function in most of the patients once e GFR <60 ml/min/1.73mml.
Topics: Female; Humans; Kidney Diseases; Male; Transplantation, Homologous
PubMed: 33158468
DOI: 10.1016/j.bpg.2020.101690 -
Best Practice & Research. Clinical... Dec 2001Only one-fourth of patients with fatal haematological disorders and malignancies will have an HLA-matched sibling donor to create access to potentially curative... (Review)
Review
Only one-fourth of patients with fatal haematological disorders and malignancies will have an HLA-matched sibling donor to create access to potentially curative allogeneic stem cell transplantation. Advances in medical management, preparation of the graft and prevention of transplant-related complications, particularly rejection and GVHD, now make it possible to use alternative donors who are not genetically HLA-histocompatible with the patient. Some patients identify unrelated donor options using adult volunteers or cord blood units. All patients have immediate access to one or more genetically half-matched (haplo-identical), HLA partially-mismatched related donors. Using safer non-cytotoxic therapies to ablate the patient's immune system, graft preparation to decrease T-lymphocyte and/or increase CD 34+ cell doses, and post-transplant GVHD and infection prophylaxis, rates >95% for engraftment and <25% for grade II-IV GVHD can be achieved. Thus, disease-free survival rates are comparable to other alternative donors with all outcomes adversely influenced by advanced disease status, poor medical performance and older age.
Topics: Graft vs Host Disease; Haplotypes; Histocompatibility; Histocompatibility Testing; Humans; Stem Cell Transplantation; Transplantation, Homologous
PubMed: 11924919
DOI: 10.1053/beha.2001.0170