Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Expert Rev Clin Immunol. 2012 Sep;8(7):673-83; quiz 684. doi: 10.1586/eci.12.54.
Hand transplantation, despite all initial skepticism, has developed from myth to reality over the past decade and has shown highly encouraging immunological and functional outcomes. However, the requirement of life-long, multidrug immunosuppression bearing the risk of serious side effects still remains the limiting factor for widespread clinical application of this novel reconstructive modality. Recent advances in immunosuppressive drug development and the design of novel cell-based therapeutic strategies that take into consideration the unique immunological and biological aspects of vascularized composite allografts have shown favorable results with regard to minimization of immunosuppressive medication and tolerance induction in both translational animal studies and first clinical trials in reconstructive transplantation. This review provides an overview of the current available conventional treatment protocols and novel immunosuppression minimization concepts for hand transplantation, which ultimately could significantly favor the risk-benefit ratio for this life-changing type of transplant.
尽管最初存在诸多怀疑，但在过去十年中，手部移植已从神话变为现实，并取得了令人鼓舞的免疫学和功能学结果。然而，长期应用多种免疫抑制药物治疗且存在严重副作用风险的问题仍然是广泛应用这种新型重建方式的限制因素。免疫抑制药物研发的最新进展以及基于细胞的新型治疗策略的设计，考虑到带血管复合移植物的独特免疫学和生物学特性，在转化动物研究和重建移植的首次临床试验中均显示出减少免疫抑制药物和诱导耐受的良好效果。本文综述了目前手部移植的常规治疗方案和新型免疫抑制药物最小化概念，这最终可能显著改善这种改变生活的移植类型的风险效益比。
