User:Sonabi/Composite Tissue Allotransplantation

A Composite Tissue Allotransplantation or briefly CTA is a kind of Allotransplantation (donor and recipient are genetically different in this specific type of transplantation) in which different, but among themselves connected tissues are transplanted at the same time. The tissue that is transplanted by this way is also called a Composite Tissue Allograft. An example for such an allograft is the hand or the face.

Special about the CTA compared to a “normal organ transplantation” is the fact, that it is no life-saving operation, but it is increasing the living quality of the patient. This is particularly true, if the patient has a defect can not be repaired by using a “conventional method”. The application of prostheses will in many cases not lead to the desired results or is even impossible, e.g. if important parts of the face are destroyed after traumatic accident. Such kind of patients could be helped by moving (parts of) a donor’s face to the damaged recipient during a composite tissue allotransplantation. So this means that the transplant surgery has just advanced in a specific field in where the recipient’s living quality is improved, rahter than to simply save the patient’s life.

In spite of this, many critics are against CTA because of the serious adverse effects of the immunsuppressives (the immunsystem is suppressed by these medicaments) a recipient has to take life-long to prevent rejection of the transplanted allograft. Furthermore other points of cirtic are the possible rejection itself and ethical or moral censequences later will be discussed on.

History of Composite Tissue Allotransplantation
The history of the composite tissue allotransplantation is actually older than the history of solid organ transplantation. According to the legend sometimes called as “the miracle of the black leg” the two brothers Cosmas and Damian successfully exchanged the dead leg of theirs patients against a healthy one in the beginnings of the middle age. In the 14th and the 15th century this legend became a popular theme for some painters. Tousand years later the Italian physician Gaspare Tagliacozzi described a transplantation of a nose from a slave to his master. And finally Alexis Carrel transplanted dog legs, but he had massive problems with rejection, of cause, and all animals died.
 * for histroy of the hand transplantation see History of the hand transplantation
 * for history of the face transplantation see History of face transplantation

The first attempt of a hand transplantation on a human was performed in 1964 in Ecuador. But they had no sufficient immunsuppressive drugs (only Azathioprine and steroids) available and so they were unable to prevent rejection and they had to remove the hand just two weeks post transplant. The quality of immunsuppressiva increased in the 1980s and 90s by development of cyclosporin A and others, but that was not enough to transplant allografts made of composite tissues containing skin. This problem was firstly solved in 1997: At that time is was reported that a combined therapy uses Tacrolimus, Mycophenolic acid and Prednison is successful in preventing rejection in composite tissue allograft. Based on these findings the first hand transplantation with success for longer time was carried out on 23. September 1998 in Lyon (France): Clint Hallam got a new right hand. This hand hand was removed on 2nd Februar 2001 because of a rejection caused by denied drug ingestion. Instead, another hand transplant was performed on 23. Jannuar 1999 in Louisville, Kentucky with success up to date and another transplantation on 21st September in Guangzhou (China) in addition.

Furthermore, the first bilateral hand transplantation took place in 2000, the first face transplant in 2005 and the first bilateral arm transplantation 2008 in Munich. Until today about 85 hand (effective 2014) and 15 face transplants (effective 2011) were performed.