The Science of Reconstructive Transplantation

404 Pages·2015·10.867 MB·English

by  Gerald Brandacher (eds.)

Stem Cell Biology and Regenerative Medicine
Series Editor
Kursad Turksen, Ph.D.
[email protected]
Our understanding of stem cells has been growing rapidly over the last decade.
While the apparently tremendous therapeutic potential of stem cells has not yet
been realized, their routine use in regeneration and restoration of tissue and organ
function is greatly anticipated. To this end, many investigators continue to push the
boundaries in areas such as the reprogramming, the stem cell niche, nanotechnology,
biomimetics and 3D bioprinting, to name just a few. To capture and consolidate
some of these developments in a timely way is the objective of the volumes in
this series. We want each volume to be thought-provoking in identifying problems,
offering solutions and providing ideas to excite further innovation in the stem cell
and regenerative medicine fields.
More information about this series at http://www.springer.com/series/7896
Gerald Brandacher
Editor
The Science of Reconstructive
Transplantation
Foreword by Dr. Thomas E. Starzl
Foreword by Dr. Raimund Margreiter
Editor
Gerald Brandacher
Department of Plastic and Reconstructive Surgery
The Johns Hopkins University School of Medicine
Baltimore, MD, USA
ISSN 2196-8985 ISSN 2196-8993 (electronic)
Stem Cell Biology and Regenerative Medicine
ISBN 978-1-4939-2070-9 ISBN 978-1-4939-2071-6 (eBook)
DOI 10.1007/978-1-4939-2071-6
Library of Congress Control Number: 2015930838
Springer New York Heidelberg Dordrecht London
© Springer Science+Business Media New York 2015
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part
of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
For Barbara and Mo
Foreword: The Science of Reconstructive
Transplantation
Reconstructive transplantation is an emerging area of transplant medicine that has
become a viable option for patients with large and devastating tissue defects. Over
the past decade, a rapidly growing number of face and upper extremity transplanta-
tions have been performed worldwide with highly encouraging outcomes. Advanc-
es in microsurgical techniques, transplant immunology, and immunosuppression
have enabled such operations.
It has been a pleasure to see the life-changing impact of the hand, face, and other
composite allografts. Recipients of these grafts represent a new generation of transplant
recipient pioneers. The uniqueness of their grafts, which include donor bone marrow,
could help further elucidate the mechanisms by which transplanted organs and tissues
are accepted. In turn, novel strategies to facilitate these mechanisms may be developed.
The Science of Reconstructive Transplantation presents a comprehensive over-
view of the latest advances in basic and translational research in the field. Many
of its leaders have contributed their expertise to the inspiring book. Important top-
ics include reconstructive animal models, skin rejection, immune monitoring, stem
cell-based immunomodulation strategies, costimulatory blockade, tolerance induc-
tion, chronic rejection, ischemia–reperfusion injury, nerve regeneration, and cere-
brocortical reintegration.
The textbook should spark the interest of physicians, scientists, and surgeons,
while serving as a valuable reference for students and scholars engaged in this novel
and emerging area of transplantation.
Thomas E. Starzl, M.D., Ph.D.
Professor of Surgery
Distinguished Service Professor
Professor Emeritus
Thomas E. Starzl Transplantation Institute
University of Pittsburgh
vii
Foreword: The Science of Reconstructive
Transplantation
Although the outcome of the initial series of hand and face transplantations has
been better than any other field of transplantation, fewer than 100 upper extremity
and only 29 face transplants have been performed since the first successful hand
transplant in Lyon, France, in 1998. Wider application of reconstructive trans-
plantation is hampered to a large extent by the lifelong need for immunosup-
pression. Minimization of immunosuppression or even induction of a specific
immune tolerance has to be considered a prerequisite for further propagation of
this most fascinating field. This book covers the various aspects of reconstructive
transplantation with special emphasis on immunology. All chapters are written by
top experts in the field.
The Science of Reconstructive Transplantation is a must for every clinician and
scientist working in the field, but is also worthwhile for anyone with an interest in
new developments in medical science.
Raimund Margreiter MD
Professor Emeritus
Department of Visceral, Thoracic and Transplant Surgery
University Hospital
Innsbruck—Austria
ix
Preface
Reconstructive transplantation of vascularized composite allografts, such as hand,
face, and abdominal wall transplants, has become a clinical reality and a viable
treatment option for the patients suffering from complex tissue injuries or defects
not amenable to conventional reconstruction. Despite the fact that early and in-
termediate outcomes are highly encouraging, skin rejection, the need for chronic
immunosuppressive treatment and the relatively slow pace of nerve regeneration
continue to hamper broader clinical application and further expansion of indi-
cations. Therefore, a thorough understanding of the unique biological features
and basic mechanisms related to immunogenicity and neuroregeneration in this
novel and emerging field of transplantation is key to establishing future treatment
protocols that allow to favorably balance the risks and benefits for such non-life-
saving but life-changing types of transplants. This was the impetus to embark
on this project and create a book entirely devoted to research in reconstructive
transplantation.
Written by renowned scientists and leaders and pioneers in the field, The Sci-
ence of Reconstructive Transplantation thus presents a comprehensive overview of
the latest advances in basic and translational research in the field of reconstructive
transplantation with a particular emphasis on its potential therapeutic implications.
The book has been structured into two parts. Part I gives an overview of the
history and development of reconstructive transplantation, discusses what can be
learned from the experiences and successes over the past 60 years in solid organ
transplantation, and provides insights from a recipient perspective describing the
experience and daily life of the first US patient receiving a combined forearm and
hand transplant. Part II concentrates on individual research areas, spanning topics
such as the use of small and large animal models for reconstructive transplantation
research, mechanism and diagnosis of skin rejection, immune monitoring concepts,
cell-based immunomodulatory strategies, tolerance induction, chronic rejection,
ischemia–reperfusion injury, models and tools to assess nerve regeneration, and
cortical reintegration of vascularized composite allografts. While this volume is
certainly not inclusive of all areas of transplantation research, it contains topics that
are of major current interest and have significant potential for translation and future
clinical applications.
xi
xii Preface
Thus, the audience for this book includes biomedical researchers and basic
scientists in the field of reconstructive transplantation, transplant immunology,
and regenerative medicine, as well as clinicians, surgeons, and multidisciplinary
specialists, interested in this novel and exciting field.
I am extremely grateful to Drs. Thomas E. Starzl and Raimund Margreiter for
writing the forewords to this book. Dr. Starzl has taught me about the fundamental
and natural laws of immunology. In addition, by sharing his personal reflections on
one of the most exceptional transplant journeys, he taught me that through relent-
less pursuit of a goal and vision, eventually stunning successes can be achieved in
a novel discipline. My surgical teacher and mentor, Dr. Margreiter, has involved
me in reconstructive transplantation in the very early days of the field as a young
resident and has supported my efforts throughout my entire professional career. He
has been and remains to be the ultimate role model of a surgeon-scientist.
Finally, I would like to express my sincere appreciation to all the contributors for
sharing their experience and knowledge in this book and for their excellent manu-
scripts. I would also like to thank Springer for supporting this exciting project and
the opportunity to edit this volume.
Baltimore, MD, USA Gerald Brandacher, MD