Cendales L, Hardy M A
Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, USA.
Microsurgery. 2000;20(8):412-9. doi: 10.1002/1098-2752(2000)20:8<412::aid-micr12>3.0.co;2-m.
Successful clinical transplantation of the upper extremity has been performed in several centers. In contrast with the recipients of other immediately vascularized organ allografts, the candidate for upper extremity transplantation has been, at least during the initial effort, a healthy patient. Although it is clear that composite tissue transplantation (CTA) is a form of allografting that behaves in many ways similarly to immediately vascularized organ allografts, the issue of developing immunologic understanding of such new allografts, awaits greater clinical experience. A summary of the immunosuppressive management of the patients who received hand allografts, with a view to explore the immunologic advantages and disadvantages as well as graft toxicity of the commonly used agents, is reported. This brief overview of the immunologic considerations in CTA is presented with the purpose of summarizing the main issues that contribute to the ultimate goal of achieving tolerance. These considerations include (1) the recipients before transplantation, (2) the donors including possible pretreatment, (3) immunosuppression for induction, maintenance, and treatment of acute rejection and its diagnosis, and (4) future potential for tolerance induction.
多个中心已成功开展了上肢的临床移植手术。与其他即刻血管化同种异体器官移植受者不同，上肢移植的候选者，至少在最初阶段，是健康患者。虽然复合组织移植（CTA）是一种同种异体移植形式，在许多方面与即刻血管化同种异体器官移植相似，但对这种新型同种异体移植的免疫学认识的发展问题，仍有待更多的临床经验。本文报告了接受手部同种异体移植患者的免疫抑制管理总结，旨在探讨常用药物的免疫优势、劣势以及移植物毒性。本文对CTA中的免疫学考量进行简要概述，目的是总结有助于实现耐受这一最终目标的主要问题。这些考量包括：（1）移植前的受者；（2）供者，包括可能的预处理；（3）诱导、维持免疫抑制以及急性排斥反应的治疗及其诊断；（4）未来诱导耐受的潜力。
