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Clinical and Developmental Immunology
Volume 2012, Article ID 438078, 11 pages
Review Article

The Need for Inducing Tolerance in Vascularized Composite Allotransplantation

1Department of Surgery, Duke University Medical Center (DUMC) 3512, Durham, NC 27710, USA
2Institute for Cellular Therapeutics and Jewish Hospital, University of Louisville, 570 South Preston Street, Suite 404, Louisville, KY 40202-1760, USA

Received 5 July 2012; Accepted 14 September 2012

Academic Editor: Gerald Brandacher

Copyright © 2012 Kadiyala V. Ravindra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Successful hand and face transplantation in the last decade has firmly established the field of vascularized composite allotransplantation (VCA). The experience in VCA has thus far been very similar to solid organ transplantation in terms of the morbidity associated with long-term immunosuppression. The unique immunological features of VCA such as split tolerance and resistance to chronic rejection are being investigated. Simultaneously there has been laboratory work studying tolerogenic protocols in animal VCA models. In order to optimize VCA outcomes, translational studies are needed to develop less toxic immunosuppression and possibly achieve donor-specific tolerance. This article reviews the immunology, animal models, mixed chimerism & tolerance induction in VCA and the direction of future research to enable better understanding and wider application of VCA.