Many different types of tissues can be transplanted, including skin, bone, cartilage, adrenal tissue, fetal thymus, corneas, and composite transplantation of tissues to restore the face or extremities.
(See also Overview of Transplantation and Corneal 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 immunosuppressionImmunosuppressants Used to Treat Transplant Rejection). Sometimes topical creams containing calcineurin inhibitors or corticosteroids are used.
Skin grafts
Skin grafts may be
Autografts
Allografts
Cartilage Transplantation
Cartilage transplantation is used for children with congenital nasal or ear defects and adults with severe injuries or joint destruction (eg, severe osteoarthritis). Chondrocytes are more resistant to rejection, possibly because the sparse population of cells in hyaline cartilage is protected from cellular attack by the cartilaginous matrix around them. Immunosuppression is therefore not indicated. The long-term benefit of various forms of cartilage transplantation for treatment of osteoarthritis is unclear.
Bone Transplantation
Bone transplantation is used for reconstruction of large bony defects (eg, after massive resection of bone cancer). No viable donor bone cells survive in the recipient, but dead matrix from allografts can stimulate recipient osteoblasts to recolonize the matrix and lay down new bone. This matrix acts as scaffolding for bridging and stabilizing defects until new bone is formed.
Cadaveric allografts are preserved by freezing to decrease immunogenicity of the bone (which is dead at the time of implantation) and by glycerolization to maintain chondrocyte viability.
No postimplantation immunosuppressive therapy is used. Although patients develop anti-human leukocyte antigen (HLA) antibodies, early follow-up detects no evidence of cartilage degradation.
Adrenal Autografting
Adrenal autografting by stereotactically placing adrenal medullary tissue within the central nervous system has been reported to alleviate symptoms in patients with Parkinson disease.
Allografts of adrenal tissue, especially from fetal donors, have also been proposed. Fetal adrenal medullary tissue stereotactically implanted in the striatum of patients with Parkinson disease has been reported to reduce rigidity and bradykinesia. However, with the ethical and political debates about the propriety of using human fetal tissue, a controlled trial large enough to adequately assess fetal neural transplantation appears unlikely.
Xenografts of endocrinologically active cells from porcine donors are being tested.
Thymus Implants
Fetal thymus tissue obtained from stillborn infants may restore immunologic responsiveness when transplanted into children with thymic aplasia and resulting abnormal development of the lymphoid system (DiGeorge syndrome).
Because the recipient is immunologically unresponsive, immunosuppression is not required; however, severe graft-vs-host disease may occur.
Uterine transplants
Uterine transplantation has been done in a small number of women with infertility due to uterine factors (eg, absence or abnormalities of the uterus). The procedure carries significant risk of morbidity, including the need for multiple procedures and risk associated with posttransplantation immunosuppression. The transplanted uterus is removed when childbearing is complete
