Solid organ transplantation has clearly come of age, and within a relatively short period of time, transplantation developed from just an exploratory procedure to a preferred treatment of choice for end-stage organ failure. From a clinical perspective, the short-term transplant survival has been excellent now, with 1-year survival greater than 90% for most organ transplants in the clinic. This remarkable accomplishment has resulted in significant advances in many other fronts in clinical medicine, including vascularized composite tissue allotransplantation (VCA) for trauma patients whose injuries are just beyond repair by conventional surgeries. The current experience with hand and face transplantation in the world for those with debilitating and dysfiguring injuries has generated tremendous enthusiasm in that transplantation of multiple different tissues and organs together as a single unit (like a hand) can offer a therapeutic option for some patients that otherwise have no choice of treatment at all.
However, VCA for burn and trauma patients creates both challenges and opportunities. Composite tissue grafts (e.g., limbs and face transplants), like most transplanted organs, are subject to immune attacks by the recipients. However, unlike other solid organ transplantation, composite tissue transplants are composed of multiple tissues with different functional properties, including skin, muscle, bone, and nerves. These tissues also have different immunological features. Therefore, it is important to elucidate the key features unique to individual tissues and how such different tissues interface with the recipient’s immune system. To date, patients with a composite tissue transplant have to take immunosuppression drugs for life, the risk and the benefit of VCA versus side effects of long-term immunosuppression need to be carefully considered. Key areas of future investigation should include fundamental mechanisms of composite tissue rejection, new protocols aimed at producing transplant survival without lifelong immunosuppression drugs, and innovative ways to minimize tissue injury and foster tissue regeneration.
This collection on transplant immunology presented recent developments in several areasof VCA, focusing on regulatory cells, cytokines regarding to immune responses, chronic rejectionand transplant tolerance, as well as new emerging therapies.
This series was published in Burns & Trauma.
EDITORIAL
New progress in immunobiology and transplantation research
Xian C. Li
Burns & Trauma 2014 2:20010001
Published on: January 2014
REVIEW
Pathological conditions re-shape physiological Tregs into pathological Tregs
William Y Yang, Ying Shao, Jahaira Lopez-Pastrana, Jietang Mai, Hong Wang and Xiao-feng Yang
Burns & Trauma 2015 3:1
Published on: 28 May 2015
REVIEW ARTICLE
Current status of vascularized composite tissue allotransplantation
Karoline Edtinger, Xiaoyong Yang, Hanae Uehara and Stefan G. Tullius
Burns & Trauma 2014 2:20020053
Published on: April 2014
REVIEW ARTICLE
Chronic allograft rejection: A significant hurdle to transplant success
Malgorzata Kloc and Rafik M. Ghobrial
Burns & Trauma 2014 2:20010003
Published on: January 2014
REVIEW ARTICLE
Cytokine regulation of immune tolerance
Jie Wu, Aini Xie and Wenhao Chen
Burns & Trauma 2014 2:20010011
Published on: January 2014
REVIEW ARTICLE
Role of CD8+ regulatory T cells in organ transplantation
Jiyan Su, Qingfeng Xie, Yang Xu, Xian C. Li and Zhenhua Dai
Burns & Trauma 2014 2:20010018
Published on: January 2014
ORIGINAL ARTICLE
Mixed lymphocyte reaction induced by multiple alloantigens and the role for IL-10 in proliferation inhibition
Junyi Zhou, Weifeng He, Gaoxing Luo and Jun Wu
Burns & Trauma 2014 2:20010024
Published on: January 2014