It's an important step towards greater availability of hand and face transplants. A procedure developed at the MGH to induce immune tolerance to organ transplants has now been shown to also induce tolerance to model tissue transplants in miniature swine.
Hand and face transplants involve transplanting several types of tissue – such as muscle, bone, skin, nerves and blood vessels – in what is called a vascularized composite allograft (VCA). As with traditional organ transplants, patients receiving VCAs need to be on lifelong immunosuppressive drugs.
Adapting an approach developed in the MGH Transplantation Biology Research Center, investigators transplanted bone marrow from the same immunologically-mismatched donors that provided tissues for the VCAs. The bone marrow transplant was performed either several months before or simultaneously with the VCA. The researchers reported in the American Journal of Transplantation that immunosuppressive drugs were no longer necessary to prevent rejection in those animals that received bone marrow.
“While offering significant improvement in recipients’ quality of life, VCA procedures such as hand and face transplants are not lifesaving, so justifying a lifetime of anti-rejection medication and their potentially dangerous side effects can be difficult. The induction of immunologic tolerance – essentially tricking a recipient’s immune system into accepting donor tissue – could be a way around that, negating the need for immunosuppressive drugs,” says Curtis L. Cetrulo, Jr., MD, FACS, of the Hand Transplantation Service in the MGH Division of Plastic and Reconstructive Surgery and senior author of the report.
“Bringing immunologic tolerance to hand and face transplantation would result in a paradigm shift in how we treat the horrific injuries our service members are sustaining in the current military conflicts, as well for the types of blast-injury extremity loss seen in the Boston Marathon bombing.”
Read more articles from the 01/17/14 Hotline issue.