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Abstract
The rapid growth of tissue banking and associated international organisations following the fall of the Berlin wall in 1991 is described. This surge in collaboration led to a world-wide constructive movement to use and to produce human tissues. As the years progressed industrialisation, led by the USA, improved the quality of tissue allografts but led higher costs and consolidation within the developing industry. The growth of litigation more than kept pace with the industrial progress. One landmark case is described, the outcome of which could revolutionise the current practices now applied to eliminate possible viral contamination of implanted tissue grafts.
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Affiliation(s)
- Glyn O Phillips
- Phillips Hydrocolloids Research Ltd (Wales and China), 2 Plymouth Drive, Radyr, Cardiff, CF15 8BL, Wales, UK.
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3
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Šatej M, Zupanič Slavec Z. Development of homologous skin, bone and other soft tissues transplantation in Slovenia. Acta Med Hist Adriat 2017; 15:151-158. [PMID: 29309179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Slovenia, transplantation of tissues such as skin and bone was successfully following global trends throughout its history. First documented homologous skin graft was already mentioned back in 1901. Alongside with new discoveries in immunology and advancements in burn surgery, skin transplantation development surged in the second half of 20th century. Slovenia's first and currently the only skin bank was established in 1973, in Ljubljana. Throughout its existence it always managed to supply skin grafts for patients that were in vast majority burn victims. The bone bank was established twenty years earlier, in 1952. Homologous bone grafts helped patients with trauma injuries and tumour resections. Besides skin and bone grafts, cartilage and other soft tissues have also been used for transplantation - tympanic membrane and cartilage transplants being used in ear surgery. International inclusion of Slovenian physicians allowed comparable results and introduction of new methods at home and around the world.
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Affiliation(s)
- Matija Šatej
- Faculty of Medicine, University of Ljubljana, Slovenia.
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Cudkowicz G, Bennett M. Pillars Article: Peculiar Immunobiology of Bone Marrow Allografts: II. Rejection of Parental Grafts by Resistant FI Hybrid Mice. J Exp Med. 1971. 134: 1513-1528. J Immunol 2015; 195:2946-2961. [PMID: 26386037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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5
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Brent L. Cells versus antibodies in allograft destruction - A historical perspective. Clin Transpl 2013:269-271. [PMID: 25095517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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6
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Abstract
The year 2009 marked the fiftieth anniversary of the first successful allogeneic haematopoietic stem cell transplant (HSCT). The field of HSCT has pioneered some of the most exciting areas of research today. HSCT was the original stem cell therapy, the first cancer immune therapy and the earliest example of individualized cancer therapy. In this Timeline article we review the history of the development of HSCT and major advances made in the past 50 years. We highlight accomplishments made by researchers who continue to strive to improve outcomes for patients and increase the availability of this potentially life-saving therapy for patients with otherwise incurable malignancies.
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Affiliation(s)
- Robert R Jenq
- Department of Immunology and Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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7
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Abstract
A century ago, the German botanist Hans Winkler (best known for coining the term 'genome') accomplished two novel transplantations. First, he produced a single plant that grafted together two completely disparate species: tomato and nightshade. Second, he chose the descriptive word 'chimaera' to name his innovation, transplanting the term from mythology to biology. This paper features Mrs McK, the first human chimera, and thus follows the term from botany to clinical medicine. Her remarkable story, pieced together from the notes, drafts and correspondence of Robert Race and his colleagues at the MRC Blood Group Unit, draws attention to the significance of names and naming.
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Affiliation(s)
- Aryn Martin
- Department of Sociology, York University, 4700 Keele Street, Toronto, Ontario, Canada.
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8
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Duhamel P, Bey E, Petit F, Cariou JL. [Experimental and clinical experience of composite tissues allotransplantation in reconstructive surgery]. ANN CHIR PLAST ESTH 2007; 52:399-413. [PMID: 17597279 DOI: 10.1016/j.anplas.2007.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 05/17/2007] [Indexed: 12/22/2022]
Abstract
Composite tissue allotransplantation (CTA) is a new concept in reconstructive surgery to improve major physical defects with no current solution. Although not a life-saving procedure, tissue replacement by CTA offers great potential for improving quality of life but relies on lifelong immunotherapy. This new practice has become achievable with the refinement of microsurgical techniques, with experience gained from limb and scalp replantations, with the development of organ transplantation and the release of new immunosuppressive drugs. Experimental and clinical research made it possible. The first human cases of CTA proved the reality and the feasibility of the concept. While the early functional results of these allografts are encouraging, they will need to be assessed in the long-term, and development of less toxic - more efficient immonu-suppressive drugs will be a permanent requisite to the broadening of CTA. Although long-term outcome and potential adverse effects of chronic immunosuppression remain uncertain, as for organ transplantation, CTA is already a potential solution for some highly selected patients carrying physical disabilities such as large facial defects and bilateral hand amputation.
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Affiliation(s)
- P Duhamel
- Service de chirurgie plastique et maxillofaciale, hôpital d'instruction des Armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France.
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Barker JH, Stamos N, Furr A, McGuire S, Cunningham M, Wiggins O, Brown CS, Gander B, Maldonado C, Banis JC. Research and Events Leading to Facial Transplantation. Clin Plast Surg 2007; 34:233-50, ix. [PMID: 17418674 DOI: 10.1016/j.cps.2006.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Facial transplantation has long captured the interest and imagination of scientists, the media, and the lay public. Facial transplantation could provide an excellent alternative to current treatments for facial disfigurement caused by burns, trauma, cancer extirpation, or congenital birth defects. This article discusses the major technical, immunologic, psychosocial and ethical hurdles that have been overcome to bring facial transplantation from an idea to a clinical reality by providing the reader with a chronologic overview of the research and events that have led this exciting new treatment into the clinical arena.
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Affiliation(s)
- John H Barker
- Department of Surgery, 511 South Floyd Street, 320 MDR Building, University of Louisville, Louisville, KY 40202, USA.
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10
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Sun J, Shi CR. [Advances in testicular allotransplantation]. Zhonghua Nan Ke Xue 2007; 13:61-4. [PMID: 17302039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Testicular allotransplantation is one of the effective options for the treatment of male infertility and hypogonadism. Since the first experimental testis transplantation, nearly 3 centuries have passed and great strides have been made in this field. Nevertheless there remain some problems that call for the attention of the medical world. Based on varieties of related literature, this paper gives a general review of the history, the status quo and the prospects of testicular allotransplantation.
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Affiliation(s)
- Jie Sun
- Department of Surgery, Xinhua Hospital, Shanghai Children's Medical Center, Shanghai 200127, China.
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Gordon CR, Nazzal J, Lozano-Calderan SA, Lee SGP, Lee WPA, Siemionow M, Matthews MS, Hewitt CW. From experimental rat hindlimb to clinical face composite tissue allotransplantation: Historical background and current status. Microsurgery 2006; 26:566-72. [PMID: 17091477 DOI: 10.1002/micr.20296] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose of this article is to review the historical background and clinical status of composite tissue allotransplantation and to discuss the scientific evolution of clinical face transplantation. Composite tissue allotransplantation (CTA) rapidly progressed in the 1980s with the discovery of cyclosporine. Although the most success has been achieved with hand transplantation, others have made progress with allografts of trachea, peripheral nerve, flexor tendon apparatus, vascularized knee, larynx, abdominal wall, and most recently, partial face. The world's first partial face allotransplantation occurred in November 2005 in France. In April of 2006, there was a second performed in China. As of today, there are now multiple institutions with plans to attempt the world's first full facial/scalp transplant. Complete facial/scalp allotransplantation offers a viable alternative for unfortunate individuals suffering severe facial disfigurement and is a product of many decades of experimental research, beginning with rat hindlimb allografts.
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Affiliation(s)
- Chad R Gordon
- Department of Surgery, Robert Wood Johnson Medical School, Cooper University Hospital, Camden, New Jersey 08103, USA.
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14
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Abstract
The present historical review reports the clinical experiences of transplantations from animal to human. The first transplantation attempts were made without any knowledge of the species barrier. The pioneers of xenotransplantation realized xenotransfusions as early as the 16th century, then cell and tissue xenotransplantations in the 19th century. At the beginning of the 20th century, xenotransplantation of testicles became the latest craze. At the same time, and later in the 1960s, organ xenotransplantations were attempted, with disappointing results. Mathieu Jaboulay, Serge Voronoff, Keith Reemtsma, James Hardy, Denton Cooley, Thomas Starzl, Christiaan Barnard and Leonard Bailey were among the pionneers of xenotransplantation. Recent trials concerned above all tissue and cell xenotransplantations. Nowadays, with encapsulation, transgenesis, and cloning, great advances have been made for controlling xenograft rejection, but ethical questions linked to the risk of infections have become a major pre-occupation within the scientific community and the general population.
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Affiliation(s)
- Jack-Yves Deschamps
- Department of Cellular and Molecular Immuno-Endocrinology, University of Nantes/Veterinary School of Nantes, ENVN, Atlanpole, La Chantrerie, BP 40706, 44307 Nantes Cedex 03, France.
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Bey E, Brachet M, Lambert F, Cariou JL. [Microsurgery: History of instrumental vascular anastomoses, our experience with eversion-stapling using VCS forceps]. ANN CHIR PLAST ESTH 2005; 50:12-8. [PMID: 15695006 DOI: 10.1016/j.anplas.2004.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 11/30/2004] [Indexed: 10/25/2022]
Abstract
One century, after Carrel in 1906, technics of vascular surgery are the same. After two world wars, peace surgery has been improved by war surgery. Microscopy surgery gave a new way for vascular surgery which became microsurgery with specific instrumentation. We have move from the developing period of microsurgery in the 1970s, to the fully matured period of microsurgery in the 1980s and the the development of clinical free flaps. The 1990s must be the turning point from autogenous tissue transplantation to allogenic transplantation. Ethic comity keeps keys of future! About microvascular anastomoses, many instrumental technics are explored but no-one is better than the classic manual suture. For us, the best instrumental technic is the anastomose with titanium clips VCS((R)) but we only use it in good situation without difficulties.
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Affiliation(s)
- E Bey
- Service de chirurgie plastique, H.I.A. Percy, 92141 Clamart cedex, France.
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16
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Grinfeder C, Pinsolle V, Pelissier P, Martin D, Baudet J. [Contribution of French surgeons to reconstructive microsurgery]. ANN CHIR PLAST ESTH 2005; 50:2-11. [PMID: 15695005 DOI: 10.1016/j.anplas.2004.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2004] [Accepted: 11/05/2004] [Indexed: 10/25/2022]
Abstract
The authors report the contribution of French surgeons and particularly the plastic surgeons to the reconstructive microsurgery since 1972. Different domains are reviewed: animal experimentation, anatomical studies, reimplantations, free tissular transfer, free bone transfer, strategic original concept of transfer, free toes transfer, microsurgical reconstruction of malformative hand, free lymphatic transfer, nervous microsurgery, flap prefabrication, allotransplantations and the future of microsurgery. Three societies have the place of honour: the French Society of Plastic Reconstructive and Aesthetic Surgery, the Group for Advancement of Microsurgery and the World Society for Reconstructive Microsurgery.
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Affiliation(s)
- C Grinfeder
- Service de chirurgie plastique, hôpital Pellegrin-Tondu, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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17
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Affiliation(s)
- Peter J Morris
- Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London
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18
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Orosz CG. A nonscientific tribute to another scientist. Transplantation 2004; 78:309-10. [PMID: 15282932 DOI: 10.1097/01.tp.0000136102.57277.c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
During the past 50 years, the role of allogeneic hematopoietic cell transplantation (HCT) has changed from a desperate therapeutic maneuver plagued by apparently insurmountable complications to a curative treatment modality for thousands of patients with hematologic diseases. Now, cure rates following human leukocyte antigen (HLA) allogeneic HCT with matched siblings exceed 85% for some otherwise lethal diseases, such as chronic myeloid leukemia, aplastic anemia, or thalassemia. In addition, the recent development of non-myeloablative conditioning and stem cell transplantation has opened the way to include elderly patients with a wide variety of hematologic malignancies. Further progress in adoptive transfer of T cell populations with relative tumor specificity would make the transplant procedure more effective and would extend the use of allogeneic HCT for treatment of non-hematopoietic malignancies.
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Affiliation(s)
- Frédéric Baron
- Transplantation Biology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA
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20
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Harada M. [Progress in the field of hematology in the last 100 years: Hematopoietic stem cell transplantation]. Nihon Naika Gakkai Zasshi 2002; 91:2019-23. [PMID: 12187668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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22
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Leeds FH. Regarding "The 50th anniversary of abdominal aortic reconstruction". J Vasc Surg 2002; 35:406-7. [PMID: 11854747 DOI: 10.1067/mva.2002.119033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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Buckner CD, Epstein RB, Rudolph RH, Clift RA, Storb R, Thomas ED. Allogeneic marrow engraftment following whole body irradiation in a patient with leukemia. 1970. ACTA ACUST UNITED AC 2001; 10:201-8. [PMID: 11359667 DOI: 10.1089/15258160151134845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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24
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Plagne R, Maraninchi D. [Hematopoietic cell transplantation: some historic milestones]. Bull Cancer 2001; 88:822-5. [PMID: 11604352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- R Plagne
- Centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand Cedex 1
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25
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Good RA, Verjee T. Historical and current perspectives on bone marrow transplantation for prevention and treatment of immunodeficiencies and autoimmunities. Biol Blood Marrow Transplant 2001; 7:123-35. [PMID: 11302546 DOI: 10.1053/bbmt.2001.v7.pm11302546] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary immunodeficiency diseases often fully meet the definition of "experiments of nature." Much of the expanding understanding of the lymphoid systems and immunologic functions generated in recent years has been derived from studying patients with primary, generally genetically determined immunodeficiency diseases, as well as other relatively rare secondary immunodeficiency diseases. Increasing knowledge of immunologic defenses, their interacting cellular and molecular components, the evolving details of sequential stages of cellular differentiation, and the nature and control of the cellular and molecular interactions in immunity have now made it possible to define precisely many primary immunodeficiency diseases in full molecular genetic terms. With this wealth of scientific information based on experimental and clinical research, incredible advances have also been made in using bone marrow transplantation (BMT) often as a curative treatment for immunodeficiency, some 60 to 70 other diseases, leukemias, lymphomas, other cancers, and a rapidly expanding constellation of metabolic diseases or enzyme deficiencies. Also, progress in applying allogeneic BMT to prevent, treat, and cure complex autoimmune diseases, primary immunodeficiency diseases and certain forms of cancers, is considered. Further, mixed BMT (syngeneic plus allogeneic) that establishes a form of stable mixed chimerism has also been employed in animal experiments, which revealed that BMT can be used to treat not only immunodeficiency diseases, but also systemic and organ-specific autoimmune diseases, eg, diabetes and erythematous lupus-like diseases. Moreover, performing BMT in conjunction with organ allografts, eg, thymus or pancreatic transplants, has successfully prevented rejection of these allografts, sometimes without recourse to long-term irradiation or toxic chemical immunosuppressive agents. A crucial role for stromal cells in cellular engineering has now also been realized in animal models as a means of preventing graft rejection and promoting full and persistent reconstitution or correction of genetically-based diseases. With all of these achievements, BMT promises continued dramatic and impressive new approaches to clinical and scientific research and reveals an attractive strategy for the treatment and prevention of many currently intractable human diseases. If these achievements can be extended to larger outbred animals and humans, BMT may set the stage for induction of improved immunologic tolerance and for developing treatments for additional intractable human diseases in the 21st century.
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Affiliation(s)
- R A Good
- University of South Florida, All Children's Hospital, St. Petersburg 33701, USA.
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26
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Affiliation(s)
- S G Friedman
- North Shore University Hospital, Division of Vascular Surgery, Manhasset, NY 11030, USA.
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27
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Abstract
The emergence of transplantation has seen the development of increasingly potent immunosuppressive agents, progressively better methods of tissue and organ preservation, refinements in histocompatibility matching, and numerous innovations in surgical techniques. Such efforts in combination ultimately made it possible to successfully engraft all of the organs and bone marrow cells in humans. At a more fundamental level, however, the transplantation enterprise hinged on two seminal turning points. The first was the recognition by Billingham, Brent, and Medawar in 1953 that it was possible to induce chimerism-associated neonatal tolerance deliberately. This discovery escalated over the next 15 years to the first successful bone marrow transplantations in humans in 1968. The second turning point was the demonstration during the early 1960s that canine and human organ allografts could self-induce tolerance with the aid of immunosuppression. By the end of 1962, however, it had been incorrectly concluded that turning points one and two involved different immune mechanisms. The error was not corrected until well into the 1990s. In this historical account, the vast literature that sprang up during the intervening 30 years has been summarized. Although admirably documenting empiric progress in clinical transplantation, its failure to explain organ allograft acceptance predestined organ recipients to lifetime immunosuppression and precluded fundamental changes in the treatment policies. After it was discovered in 1992 that long-surviving organ transplant recipients had persistent microchimerism, it was possible to see the mechanistic commonality of organ and bone marrow transplantation. A clarifying central principle of immunology could then be synthesized with which to guide efforts to induce tolerance systematically to human tissues and perhaps ultimately to xenografts.
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Affiliation(s)
- T E Starzl
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA 15213, USA
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Parrish FF. Treatment of bone tumors by total excision and replacement with massive autologous and homologous grafts. 1966. Clin Orthop Relat Res 2000:3-10. [PMID: 10810456 DOI: 10.1097/00003086-200004000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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29
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Jensen JN, Mackinnon SE. Composite tissue allotransplantation: a comprehensive review of the literature--part 1. J Reconstr Microsurg 2000; 16:57-68. [PMID: 10668755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J N Jensen
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Affiliation(s)
- E D Thomas
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle 98109, USA
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31
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Nechaĭ AI. [The question of the 1st in the world cadaveric kidney allotransplantation to man]. Vestn Khir Im I I Grek 1999; 158:101-2. [PMID: 10533241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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32
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Burwell RG. Studies in the transplantation of bone. V. The capacity of fresh and treated homografts of bone to evoke transplantation immunity. 1963. Clin Orthop Relat Res 1999:S5-11; discussion S2-4. [PMID: 10546631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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33
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Affiliation(s)
- A P Monaco
- Harvard University, Boston, Massachusetts, USA
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34
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Affiliation(s)
- F T Rapaport
- Department of Surgery, Health Sciences Center, State University of New York, Stony Brook 11794-8192, USA
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Calne RY, Thiru S, McMaster P, Craddock GN, White DJ, Evans DJ, Dunn DC, Pentlow BD, Rolles K. Cyclosporin A in patients receiving renal allografts from cadaver donors. 1978. J Am Soc Nephrol 1998; 9:1751-6. [PMID: 9727384 DOI: 10.1681/asn.v991751] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
The arguments for and against minimizing HLA antigen mismatching in clinical transplantation have been debated for the past 30 years (Terasaki & Cecka, 1994), but at least two major kidney exchange programmes (EURO- and UK-Transplant), with waiting lists totalling 17 thousand patients, prioritize the least HLA mismatched recipients. In the USA, in the United Network for Organ Sharing (UNOS) zero HLA-A,-B, DR mismatch for exchange of kidneys is mandatory. There is now a clear understanding of the in vivo function of HLA molecules, which have a central role in antigen presentation to T cells and thus initiate the immune response both in the normal individual and in transplant recipients. In the latter case, direct recognition of foreign HLA molecules by recipient T cells is also possible (Shoskes & Wood, 1994). With such a clear understanding of the central functional role for HLA in the immune response, it is not surprising that reports of increased kidney transplant survival correlate with reduced HLA mismatching, and it is of concern that some centres choose to allocate kidneys for transplant ignoring HLA. Reports of benefits of minimizing HLA mismatching in heart (Smith et al., 1995) and lung (Iwaki et al., 1993) transplantation are limited to retrospective studies, and no centre has claimed to allocate these organs taking HLA mismatch into account. Consequently, HLA mismatched thoracic organ transplants predominate, but nevertheless recipients of completely mismatched organs have decreased survivals (Opelz & Wujciak, 1994) and more rejection (Baan et al., 1991; Jarcho et al., 1994). Since transplantation of hearts and lungs is essentially only effective on one occasion, all effort should be made to maximize survival and incorporation of HLA mismatches in allocation criteria for these organs is now overdue (Disesa et al., 1990; Morris, 1994). In this brief review we choose not to cover the extensive literature on the role of HLA mismatching in organ transplantation, but consider the field at the present time with particular emphasis on realistic, practical application of HLA typing to the clinical situation and, in particular, the development of allocation procedures that will best suit the needs of individual patients.
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Affiliation(s)
- P A Dyer
- Tissue Typing Laboratory, St Mary's Hospital, Manchester, UK
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37
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Abstract
Arterial allografts, formerly called homografts, came into limited use in the 1940s and 1950s as arterial substitutes. Fresh allografts underwent rapid rejection. Preserved allografts had a longer but still limited clinical life. Allografts demonstrated that arterial replacement was a valid concept and led to the development of synthetic substitutes. Recent renewed interest is based on the need for graft replacements in re-do procedures and in an infected field. Even the best methods of graft procurement and preservation do not preserve normal endothelial and smooth muscle cell functions nor eliminate antigenicity. The biologic and economic costs of immune suppression to obtain a successful allograft for an ischaemic limb are presently unjustifiable. Transplantation between species (xenotransplantation) may be attainable via selective inhibition of the complement system avoiding full immunosuppression now required for organ transplantation. At present allografts may be an acceptable choice for the patient with (1) a critical need for revascularisation and with a life expectancy not exceeding that of the graft, (2) in urgent vascular trauma, and (3) where immunosuppression is contraindicated as in an infected surgical field. Except in most unusual circumstances allografts should not be used for (1) relief of claudication, (2) in the above mid-calf location and (3) anatomic locations where synthetic grafts are superior.
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Affiliation(s)
- A D Callow
- Whitaker Cardiovascular Institute, Boston University Medical Center, University Hospital, Massachusetts, USA
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38
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Küss R. [The history of kidney transplantation]. Prog Urol 1996; 6:677-82. [PMID: 9102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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39
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Affiliation(s)
- D N Ross
- Harley Street Clinic, London, United Kingdom
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Lackman RD. Extremity reconstruction via allograft transplantation. Semin Arthroplasty 1994; 5:60-9. [PMID: 10147345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R D Lackman
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107
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Walker DG. Bone resorption restored in osteopetrotic mice by transplants of normal bone marrow and spleen cells. 1975. Clin Orthop Relat Res 1993:4-6. [PMID: 8358945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kreis RW, Hoekstra MJ, Mackie DP, Vloemans AF, Hermans RP. Historical appraisal of the use of skin allografts in the treatment of extensive full skin thickness burns at the Red Cross Hospital Burns Centre, Beverwijk, The Netherlands. Burns 1992; 18 Suppl 2:S19-22. [PMID: 1418518 DOI: 10.1016/0305-4179(92)90065-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- R W Kreis
- Red Cross Hospital, Beverwijk, The Netherlands
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Abstract
Ross' first homograft replacement of the aortic valve was reported in 1962. The homograft has been in continuous use around the world ever since. Much has been learned about how to handle homografts, both before and during their implantation. Homografts have special advantages, which make them an appropriate choice in a number of settings. This first successful case by Donald Ross set the stage for the growth in homograft valve use and the subsequent development of many ways of using allograft cardiovascular tissue for optimal cardiac reconstructions.
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Affiliation(s)
- R A Hopkins
- Department of Surgery, Georgetown University Medical Center, Washington, DC 20007-2197
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Hamburger J. [The beginning of kidney transplantation]. Rev Prat 1989; 39:1615-6. [PMID: 2665042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bahnson HT. Transplantation--resources. Matas memorial lecture. J Cardiovasc Surg (Torino) 1989; 30:1-10. [PMID: 2647759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H T Bahnson
- Department of Surgery, University of Pittsburgh, Pennsylvania
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Abstract
Since the first successful organ transplantation in 1953, we have seen an explosive development in transplantation surgery, particularly during the 1980s. With it followed an abundance of legal controversies and ethical dilemmas. Optimal use of viable organs necessitated precise definition of brain death in heart-beating cadavers with artificially maintained ventilation and circulation. Viable organs must remain well perfused to be suitable for procurement and transplantation into carefully selected recipients on an equal-opportunity basis. Due consideration must be given to both medical and social indications. At present, homografts dominate the field of organ transplantation; however, because of the shortage of human organs, both artificial organs (especially hearts) and xenografts are expected to become increasingly common in the near future. No doubt, the use of such modern technology will introduce additional ethical problems.
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Affiliation(s)
- A Grenvik
- Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine and Health Center, PA
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Affiliation(s)
- J P Vacanti
- Department of Surgery, Harvard Medical School, Boston, MA
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Otto T. [Lung and lung-heart transplantation]. Pneumonol Pol 1988; 56:137-41. [PMID: 3137533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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