immunology allergic disorders
Tissue Transplantation
Composite Transplantation (Hand, Extremity, Face)
Composite transplants (composite vascular allografts) involve multiple tissues, usually including skin and soft tissues and sometimes musculoskeletal structures. In 2021, only 4 were done in the US. Many of these procedures are now possible because of advances in immunosuppressive therapy. However, the procedures are ethically controversial because they typically do not extend life, are very expensive and resource-intensive, and can potentially cause morbidity and mortality due to infections. The first successful composite transplants were hand transplants. Since then, perhaps as many as 10 different structures have been replaced in about 150 patients, with varying functional success rates. The first hand transplantation was done in 1998. Since then, double hand and upper-extremity transplantations have been done. Recovery of the hand function varies widely; some recipients regain enough function and sensitivity to do daily activities. The first face transplantation was done in 2005. Ethical questions about face transplantation are even more prominent than those about extremity transplantation because the surgical procedure is extremely demanding and the immunosuppression required puts the recipient at considerable risk of opportunistic infections. Posttransplantation Immunosuppression usually consists of induction therapy ( 