Madani H, Hettiaratchy S, Clarke A, Butler P E M
Department of Plastic Surgery, Royal Free Hospital, London NW3 2QG, UK.
J Plast Reconstr Aesthet Surg. 2008;61(3):245-9. doi: 10.1016/j.bjps.2007.10.048. Epub 2007 Dec 20.
Composite tissue transplantation (CTA) refers to the transplantation of an allograft consisting of heterogeneous cadaveric tissues. It provides a means of restoring structural, functional and aesthetic form in severely injured patients. Recent progress in facial transplantation has highlighted the immense strides made in this field of reconstructive surgery. However the potential for improvements in quality of life must be offset by the need for life-long immunosuppression in adults with non life-threatening injuries. The benefits and difficulties of immunosuppressive drugs have been established in solid organ transplantation. Regimens derived from renal transplantation have been successfully applied to CTA. However the published incidence of complications seen in organ transplant recipients may not be easily extrapolated to potential CTA candidates and may be overstated. Accepted views that high dose immunosuppression would be needed to overcome highly antigenic tissues such as skin have not been borne out by clinical experience. It is therefore important to assess the current state of affairs, attempt to quantify the perceived risks and explore novel research methods being investigated. In doing so one can make a well-informed judgment of the potential benefit of this surgical modality as an integral part of the reconstructive ladder.
复合组织移植（CTA）是指移植由异种尸体组织组成的同种异体移植物。它为严重受伤患者提供了一种恢复结构、功能和美学形态的方法。面部移植的最新进展凸显了该重建外科领域取得的巨大进步。然而，对于非危及生命损伤的成年人，生活质量改善的潜力必须被终身免疫抑制的需求所抵消。免疫抑制药物的益处和困难在实体器官移植中已得到明确。源自肾移植的方案已成功应用于复合组织移植。然而，器官移植受者中已公布的并发症发生率可能不易外推至潜在的复合组织移植候选者，且可能被高估。认为需要高剂量免疫抑制来克服如皮肤等高抗原性组织的公认观点尚未得到临床经验的证实。因此，评估当前状况、试图量化感知到的风险并探索正在研究的新研究方法很重要。这样做可以对这种手术方式作为重建阶梯的一个组成部分的潜在益处做出明智的判断。
