Original Article
Successful Hand Transplantation — One-Year Follow-up
N Engl J Med 2000; 343:468-473August 17, 2000
- Abstract
Background
On the basis of positive results in studies of the transplantation of pig extremities and the information exchanged at an international symposium on composite-tissue transplantation, we developed a protocol for human hand transplantation.
Methods
After a comprehensive pretransplantation evaluation and informed-consent process, the left hand of a 58-year-old cadaveric donor, matched for size, sex, and skin tone, was transplanted to a 37-year-old man who had lost his dominant left hand 13 years earlier. Immunosuppression consisted of basiliximab for induction therapy and tacrolimus, mycophenolate mofetil, and prednisone for maintenance therapy.
Results
The cold-ischemia time of the donor hand was 310 minutes. There were no intraoperative or early postoperative complications. Moderate acute cellular rejection of the skin of the graft developed 6, 20, and 27 weeks after transplantation. All three episodes resolved completely after treatment with intravenous methylprednisolone and topical tacrolimus and clobetasol. Temperature, pain, and pressure sensation had developed in the hand and fingers by one year. At one year, the patient could perform many functional activities with his left hand that he had not been able to perform with his prosthesis, such as throwing a baseball, turning the pages of a newspaper, writing, and tying his shoelaces.
Conclusions
Early success has been achieved in hand transplantation with the use of currently available immunosuppressive drugs.
Media in This Article
Figure 1
Photograph of the Patient's Left Forearm Stump and Right Hand before Transplantation (Panel A) and Dorsal and Ventral Views (Panels B and C, Respectively) of the Hands One Year after Transplantation.Figure 2
Photomicrographs of Skin-Biopsy Specimens from the Grafted Hand after Transplantation.Article Activity
- Article
In 1996, the Louisville Hand Transplant Team was formed to examine the possibility of performing a human hand transplantation. One of our first goals was to develop procedures for the transplantation of allografts of extremities in large animals.1,2 In contrast to prior studies of hand transplantation in primates, in which very high doses of cyclosporine and prednisone did not prevent rejection episodes and had many adverse effects,3-5 we found that in pigs that received extremity transplants, rejection could be delayed with a regimen of cyclosporine, mycophenolate mofetil, and prednisone or a regimen of tacrolimus, mycophenolate mofetil, and prednisone.6,7 These results strengthened our belief that hand transplantation was feasible in humans.
In November 1997, we organized an international symposium to discuss the scientific, clinical, and ethical barriers to performing hand transplantation in humans. Although some participants expressed reservations about the high level of immunosuppression that might be required to prevent rejection, the majority felt that, on the basis of the data presented,8 limb transplantation in humans should be attempted, provided an appropriate experimental protocol was strictly adhered to. We therefore decided to proceed with clinical hand transplantation, but only after we had obtained the approval of the Human Studies Committee at the University of Louisville Medical School in Louisville, Kentucky, and of an ethics committee composed of people not related in any way to the institutions involved in the Louisville Hand Transplant Team. We also made public and professional disclosure of our intention to proceed, invited local as well as national commentary from the lay and medical communities before the procedure, and assessed the risk–benefit ratio for the procedure.9 Finally, on January 24, 1999, four months after the performance of the first human hand transplantation in France,10 a hand transplantation was performed at the Jewish Hospital of Louisville. In this article, we present the results at one year.
Methods
Selection and Evaluation of the Patient
Our initial screening criteria specified that eligible patients should be in good health, 18 to 65 years of age, with amputation of one or both hands at or above the wrist, and with no evidence of viral hepatitis or human immunodeficiency virus infection. A complete history was obtained, and patients underwent a physical examination; routine laboratory studies; determination of blood group and HLA type; tests for cytomegalovirus, Epstein–Barr virus, and panel-reactive antibodies in serum; electromyography; angiography; testing of nerve conduction velocity; and extensive psychological testing.
If the patient remained a candidate after these evaluations, informed consent was obtained. During this process, which was filmed with the patient's consent, we addressed the risks associated with surgery and immunosuppressive therapy, including death, rejection of the graft, serious infection, cancer, adverse drug effects, and graft amputation. In addition, the patient was asked to identify a patient advocate in his or her community. The advocate was a person not connected with the Louisville Hand Transplant Team and its member institutions, who would counsel the patient on the advisability of continuing with hand transplantation. Finally, the patient was presented to a patient-selection committee modeled after that used for solid-organ transplantation; this committee was composed of people with medical, surgical, psychiatric, and social-services expertise.
The patient selected for the initial procedure was a 37-year-old man who had lost his dominant left hand and lower forearm in a fireworks accident 13 years earlier (Figure 1AFigure 1
Photograph of the Patient's Left Forearm Stump and Right Hand before Transplantation (Panel A) and Dorsal and Ventral Views (Panels B and C, Respectively) of the Hands One Year after Transplantation.). He had a myoelectric prosthesis that permitted him to work as a paramedic. He had had type 1 diabetes mellitus for 11 years, which was treated with twice-daily doses of intermediate- and short-acting insulin, with good glycemic control. The patient was a nonsmoker. He had no evidence of diabetic retinopathy, neuropathy, nephropathy (his serum creatinine concentration was 1.0 mg per deciliter [88 μmol per liter], with no microalbuminuria), gastroenteropathy, or cardiovascular disease. Serum panel-reactive and cytomegalovirus antibodies were not detected, but antibodies to Epstein–Barr virus were present.The patient was advised of the increased risk of cytomegalovirus infection and the need for specific prophylaxis to prevent that infection if he should receive a graft from a cytomegalovirus-positive donor. He was also told that the postoperative administration of tacrolimus and cyclosporine might cause renal dysfunction and that we would discontinue these drugs if his renal function was in jeopardy. The patient clearly understood these potential risks and wished to proceed.
Selection of the Donor and Preparation of the Graft
Consent for tissue donation was obtained by the local organ-procurement organization from the family of a 58-year-old male cadaveric donor. The donor was matched to the recipient for bone size and skin tone according to preestablished guidelines. The donor had serum antibodies against cytomegalovirus and Epstein–Barr virus. The donor and recipient were discordant at all six HLA alleles.
During the dissection phase of the procurement procedure, the left upper arm of the donor was disarticulated at the elbow under tourniquet control. The limb was cooled externally by topical application of sterile saline slush and internally by perfusion of the brachial artery with University of Wisconsin solution (ViaSpan, Dupont Merck Pharmaceuticals, Wilmington, Del.) at 4°C. The resected limb was then wrapped in moist sponges, placed in a sterile bag surrounded by ice slush, and transported to another hospital two blocks away.
After removal of excess skin and bone, all arteries, nerves, and tendons to be repaired were identified. The tendons were cut at the level of their respective muscle bellies, and measurements were taken to shorten the bones appropriately. Plates were affixed to the radius and ulna.
Preparation of the Recipient and Transplantation
The skin of the stump of the recipient's left arm was incised, and the tendons, nerves, and vascular structures were freed for joining with those of the donor hand. The patient had a pronation contracture of 70 degrees, requiring release of the pronator teres. Osteotomy was performed to match the graft. The bones were fixed anteriorly with 3.5-mm fixation plates. The arteries of the donor and recipient were then joined. The total cold-ischemic time was 310 minutes.
Tendon grafts were harvested from the recipient's feet. These were used to bridge a 4-cm gap between the donor's and recipient's tendons. Recipient-to-donor repair of the tendons of the flexor digitorum profundus of digits 3, 4, and 5 and of the tendons of the extensor pollicis brevis and abductor pollicis longus was performed en masse. Recipient-to-donor repairs of other tendons were performed as follows: brachioradialis to flexor carpi radialis; extensor carpi ulnaris to extensor pollicis longus; extensor carpi radialis brevis to extensor digitorum communis; and extensor carpi radialis longus to the distal ends of the extensor carpi radialis longus and extensor carpi radialis brevis. Recipient-to-donor repair of the tendons of the flexor digitorum profundus to the index finger and the flexor pollicis longus was performed. There was evidence of neuroma, confirmed by biopsy, at the sites of nerve anastomosis in the recipient 15 cm above the wrist. Next, the venous anastomoses were completed. The skin was closed, and an autologous split-thickness skin graft approximately 6 by 10 cm was placed on the dorsal aspect of the forearm. Finally, the hand and arm were placed in a long-arm splint.
Postoperative Care
The patient was cared for in a hand-surgery unit according to protocols already in place for hand replantation.11 The care included digital temperature monitoring and anticoagulant therapy with low-molecular-weight dextran. On postoperative day 4, the arm was placed in a forearm-based, dynamic crane extension outrigger with adjustable metacarpophalangeal block, and active range-of-motion exercises of the graft were begun. The forearm and elbow were placed in a hinged elbow splint, and controlled pronation–supination was initiated. The patient was discharged from the hospital on day 11 after surgery. The rehabilitation program formulated for the recipient while he remained in the Louisville area, until three months after transplantation, is summarized in Table 1Table 1
Rehabilitation Program for a Hand-Transplant Recipient..Immunosuppressive Regimen
The patient received 20 mg of the interleukin-2–receptor antagonist basiliximab (Simulect, Novartis Pharmaceuticals, East Hanover, N.J.) intravenously immediately before surgery and on postoperative day 4. Oral therapy with tacrolimus (Prograf, Fujisawa USA, Deerfield, Ill.), at a dose of 0.15 mg per kilogram of body weight per day, was begun at the same time, with the dose subsequently adjusted to maintain 12-hour whole-blood trough concentrations between 15 and 20 ng per milliliter (as measured with the Incstar ProTrac II enzyme-linked immunosorbent assay [Diasorin, Stillwater, Minn.]).12 Mycophenolate mofetil, at a dose of 1 g twice daily, was also begun before surgery, with the dose subsequently adjusted to maintain trough plasma concentrations of mycophenolic acid between 3 and 5 ng per milliliter (as measured with the EMIT 2000 assay [Dade Behring, Deerfield, Ill.]),13 with a maximal daily dose of 3 g. Five hundred milligrams of intravenous methylprednisolone was administered intraoperatively; tapering doses were given orally, beginning on the first postoperative day (at 2 mg per kilogram per day, which was decreased to 10 mg per day by month 3). Graft-skin biopsies were performed when clinically indicated by visible signs of rejection (maculopapular rash) and according to the protocol on days 0, 5, 7, 10, 14, 21, and 30 and monthly thereafter. For prophylaxis against cytomegalovirus, 5 mg of ganciclovir per kilogram was administered intravenously every 12 hours while the patient was hospitalized, followed by oral therapy (1000 mg three times daily) until three months after transplantation.
Results
Graft Rejection
There were no complications during the intraoperative and immediate postoperative periods. Rehabilitation therapy progressed rapidly; there was less edema than after reconnection of a severed hand. Mild perivascular lymphocytic infiltrates without visible signs of rejection were noted on histologic examination of skin-biopsy specimens at 21 and 30 days, but no treatment was judged to be necessary.
At six weeks, a maculopapular rash developed circumferentially over the wrist. Skin biopsy revealed moderate acute cellular rejection, characterized by moderate perivascular and dermal lymphocytic infiltration and mild epidermal degeneration (Figure 2AFigure 2
Photomicrographs of Skin-Biopsy Specimens from the Grafted Hand after Transplantation.).2 Initial treatment consisted of intravenous methylprednisolone (total dose, 2 g over a period of three days) and topical application of tacrolimus daily for two weeks. After two weeks, a mild macular rash persisted, and topical clobetasol, a high-potency glucocorticoid, was substituted for topical tacrolimus. The rash completely resolved within a few days, and the findings on follow-up biopsy of the graft skin were normal (Figure 2B).Twenty weeks after transplantation, a rash again developed on the graft. Biopsy revealed the same histologic signs of moderate acute rejection as those seen at six weeks. The rash resolved in a week after treatment with intravenous methylprednisolone (total dose, 1 g over a period of three days) and daily topical clobetasol. The results of a follow-up biopsy were normal, as were those at six months. At 27 weeks, a rash was again noted, a biopsy was performed, and a confirmed episode of moderate rejection was treated with oral prednisone (2 mg per kilogram per day, tapered to 10 mg per day over a period of 21 days) and with topical tacrolimus and clobetasol. This episode also resolved completely, and the results of two subsequent biopsies at 32 and 52 weeks were normal.
Fifteen weeks after transplantation, the patient presented with abdominal pain and diarrhea. The workup, including colonoscopy and colon biopsy, revealed tissue-invasive cytomegalovirus disease. Intravenous ganciclovir treatment was restarted at 5 mg per kilogram twice daily for two weeks, followed by oral ganciclovir (1000 mg three times daily) for nine months, until the results of tests for cytomegalovirus DNA in serum were negative. The symptoms resolved within one week after ganciclovir therapy was reinstituted. No other complications related to immunosuppression occurred.
Functional Recovery
Skin, wound, and bone healing proceeded normally. Nerve regeneration, as assessed by the presence of Tinel's sign, progressed more rapidly than had been anticipated from our experience with replantation.14 Tinel's sign was noted in the palm (15 cm from the anastomosis of the nerves) by three months and in the fingertips (30 cm from the anastomosis) by six months. By one year, return of function was documented as follows: temperature, pain, and pressure sensation was present in the hand and fingers; there was electromyographic evidence of innervation of the intrinsic muscles of the hand; and weak adduction of the thumb was possible. At one year, the patient also had a grip strength of 2.7 kg (6 lb), 3.6 kg (8 lb), and 5.0 kg (11 lb) at three hand positions, with a lateral pinch strength of 1.4 kg (3 lb), but digital motion was limited without wrist stabilization, possibly because of tenodesis (Figure 1B and Figure 1C).
The active range of motion at the forearm and wrist and the active-flexion range of motion of the fingers without the anticlaw splint, with and without wrist stabilization, one year after transplantation are shown in Table 2Table 2
Active Range of Motion at the Forearm and Wrist One Year after Hand Transplantation. and Table 3Table 3
Active Digital-Flexion Range of Motion without Anticlaw Splint and with and without Wrist Stabilization One Year after Hand Transplantation.. At this time, the patient could perform the following activities with his left hand, which he had not been able to perform with his prosthesis before surgery: throw a baseball, swing a lightweight bat, turn pages of a newspaper, write, pick up checkers or poker chips, and tie his shoelaces.The patient was able to return to work three and a half months after the transplantation. At the one-year follow-up, his diabetes was well controlled (glycosylated hemoglobin value, 5.5 percent), although adjustments to the insulin dose were needed during the treatment of rejection episodes. The serum creatinine concentration was 1.5 mg per deciliter (133 μmol per liter); creatinine clearance was 90 ml per minute, and the results of liver-function tests and the complete blood count were normal. The patient remained psychologically well adjusted and had incorporated the graft into his self-image. He assessed his level of function with the graft as superior to that with the prosthesis he used before transplantation.
Discussion
With the goal of direct clinical application, we studied the efficacy and toxicity of several immunosuppressive regimens in pigs after allografting of extremities.6,7 In 10 animals that received cyclosporine, 2 osteomyocutaneous flaps were lost to rejection, and there was persistent, mild-to-moderate acute rejection in 5. Three pigs had pneumonia (fatal in one), two had septic arthritis, and one had wound infection. In contrast, among nine pigs that received tacrolimus, there was no rejection in eight (one had persistent mild rejection at the time of death from gastric rupture), but five pigs had pneumonia (fatal in three), four had septic arthritis, three had toe abscesses, and five had diarrhea and decreased weight gain. In these studies, however, drug doses were not adjusted according to the clinical progress of the animals, as would be done when humans are treated. Therefore, our decision to proceed with a tacrolimus-based regimen for immunosuppression after human hand transplantation was based on the hypothesis that efficacy in preventing rejection and systemic toxicity could be balanced clinically. Indeed, the immunosuppressive regimen required to prevent and treat rejection in our patient and the initial success achieved were not at all predictable from data on primates but, rather, were more in line with our findings in pigs. The functional results have been good, and nerves have regenerated many years after amputation of the native hand.
Even though our patient was seronegative for cytomegalovirus and therefore was at risk for primary cytomegalovirus disease after receiving a transplant from a seropositive donor, we, in accordance with standard practice in solid-organ transplantation in adults, did not restrict our donor pool to cytomegalovirus-negative donors. However, the risk of cytomegalovirus disease in our patient was unquestionably increased further by the administration of a potent immunosuppressive regimen containing mycophenolate mofetil and by treatment of an early episode of acute rejection with high doses of glucocorticoids. Cytomegalovirus disease developed in our patient 15 weeks after transplantation.
Our results and those of the first human hand transplantation, performed in France,10 show that early success in hand transplantation can be achieved with the use of currently available immunosuppressive drugs.
Supported in part by a grant from the Jewish Hospital of Louisville.
Source Information
From the Divisions of General Surgery (J.W.J.), Plastic and Reconstructive Surgery (J.H.B.), and Hand and Microsurgery (W.C.B.), Department of Surgery, University of Louisville School of Medicine, Louisville, Ky.; and the Division of Immunology and Organ Transplantation, Department of Surgery, University of Texas at Houston Health Science Center, Houston (S.A.G.).
Address reprint requests to Dr. Jones at Carolinas Medical Center Transplant Service, 1000 Blythe Blvd., Charlotte, NC 28203, or at jjones@carolinas.org.
Other members of the team are listed in the Appendix.
Appendix
The other members of the Louisville Hand Transplant Team were D.K. Granger, D. Pidwell, M. Klapheke, G. Tobin, C. Marcell, C. Wimsatt, C. Wilson, B. Creamer, R. van Antwerp, A.W. Jevans, D. Rogers, S. Chesher, C. Lewellyn, A. Hodges, L. Cendales, J. Kutz, T.M. Tsai, S. McCabe, A. Gupta, W. O'Neill, R. Shatford, M. Moskal, M. Favetto, H. Tien, J. Pederson, and M. Kim.
- References
References
1
Ren X ,Shirbacheh MV ,Ustuner ET , et al. Osteomyocutaneous flap as a preclinical composite tissue allograft: swine model. Microsurgery 2000;20:143-149
CrossRef | Web of Science | Medline2
Zdichavsky M ,Jones JW ,Ustuner ET , et al. Scoring of skin rejection in a swine composite tissue allograft model. J Surg Res 1999;85:1-8
CrossRef | Web of Science | Medline3
Skanes SE ,Samulack DD ,Daniel RK . Tissue transplantation for reconstructive surgery. Transplant Proc 1986;18:898-900
Web of Science4
Stark GB ,Swartz WM ,Narayanan K ,Moller AR . Hand transplantation in baboons. Transplant Proc 1987;19:3968-3971
Web of Science | Medline5
Stevens HPJD ,Hovius SER ,Heeney JL ,van Nierop PWM ,Jonker M . Immunologic aspects and complications of composite tissue allografting for upper extremity reconstruction: a study in the rhesus monkey. Transplant Proc 1991;23:623-625
Web of Science | Medline6
Ustuner ET ,Zdichavsky M ,Ren X , et al. Long-term composite tissue allograft survival in a porcine model with cyclosporine/mycophenolate mofetil therapy. Transplantation 1998;66:1581-1587
CrossRef | Web of Science | Medline7
Jones JW ,Ustuner ET ,Zdichavsky M , et al. Long-term survival of an extremity composite tissue allograft with FK506-mycophenolate mofetil therapy. Surgery 1999;126:384-388
CrossRef | Web of Science | Medline8
Barker JH ,Jones J ,Breidenbach WC , eds. Proceedings of the international symposium on composite tissue allotransplantation. Transplant Proc 1998;30:2687-27879
McCabe S ,Rodocker G ,Julliard K , et al. Using decision analysis to aid in the introduction of upper extremity transplantation. Transplant Proc 1998;30:2783-2786
CrossRef | Web of Science | Medline10
Dubernard J-M ,Owen E ,Herzberg G , et al. Human hand allograft: report on first 6 months. Lancet 1999;353:1315-1320
CrossRef | Web of Science | Medline11
Scheker LR ,Chesher SP ,Netscher DT ,Julliard KN ,O'Neill WL . Functional results of dynamic splinting after transmetacarpal, wrist, and distal forearm replantation. J Hand Surg [Br] 1995;20:584-590
CrossRef | Medline12
MacFarlane G ,Scheller D ,Ersfeld D , et al. A simplified whole blood enzyme-linked immunosorbent assay (ProTrac II) for tacrolimus (FK506) using proteolytic extraction in place of organic solvents. Ther Drug Monit 1996;18:698-705
CrossRef | Web of Science | Medline13
Meiser BM ,Pfeiffer M ,Schmidt D , et al. Combination therapy with tacrolimus and mycophenolate mofetil following cardiac transplantation: importance of mycophenolic acid therapeutic drug monitoring. J Heart Lung Transplant 1999;18:143-149
CrossRef | Web of Science | Medline14
Wang MS ,Zeleny-Pooley M ,Gold BG . Comparative dose-dependence study of FK506 and cyclosporin A on the rate of axonal regeneration in the rat sciatic nerve. J Pharmacol Exp Ther 1997;282:1084-1093
Web of Science | Medline
- Citing Articles (126)
Citing Articles
1
K. Muramatsu, A. Moriya, T. Hashimoto, T. Taguchi. (2012) Immunomodulatory effects of pre-irradiated extremity allograft in the rodent model. Journal of Plastic, Reconstructive & Aesthetic Surgery
CrossRef2
R.G.E. Clement, K.E. Bugler, C.W. Oliver. (2011) Bionic prosthetic hands: A review of present technology and future aspirations. The Surgeon 9:6, 336-340
CrossRef3
Keiichi Muramatsu, Hidetoyo Kato, Yuichiro Yoshida, Atsushi Moriya, Tomoaki Okimoto, Toshihiko Taguchi. (2011) Myeloablative Irradiation, Granulocyte-Colony Stimulating Factor, and FK506 can Induce Macrochimerism and Prolong the Survival of Experimental Extremity Allografts. Journal of Surgical Research 171:2, 807-813
CrossRef4
Tristan L. Hartzell, Prosper Benhaim, Joseph E. Imbriglia, Jaimie T. Shores, Robert J. Goitz, Marshall Balk, Scott Mitchell, Roee Rubinstein, Vijay S. Gorantla, Stefan Schneeberger, Gerald Brandacher, W.P. Andrew Lee, Kodi K. Azari. (2011) Surgical and Technical Aspects of Hand Transplantation: Is it Just Another Replant?. Hand Clinics 27:4, 521-530
CrossRef5
Kadiyala V. Ravindra, Vijay S. Gorantla. (2011) Development of an Upper Extremity Transplant Program. Hand Clinics 27:4, 531-538
CrossRef6
Abtin Foroohar, River M. Elliott, Tae Won Benjamin Kim, Warren Breidenbach, Abraham Shaked, L. Scott Levin. (2011) The History and Evolution of Hand Transplantation. Hand Clinics 27:4, 405-409
CrossRef7
Edward C Toll, Alexander M Seifalian, Martin A Birchall. (2011) The role of immunophilin ligands in nerve regeneration. Regenerative Medicine 6:5, 635-652
CrossRef8
A. Chelmoński, J. Jabłecki, T. Szajerka. (2011) Insidious Course of Cytomegalovirus Infection in Hand Transplant Recipient: Case Report, Diagnostics, and Treatment. Transplantation Proceedings 43:7, 2827-2830
CrossRef9
Jerome Lee, Angela M. Garcia, W.P. Andrew Lee, Michael C. Munin. (2011) Inpatient Rehabilitation Challenges in a Quadrimembral Amputee After Bilateral Hand Transplantation. American Journal of Physical Medicine & Rehabilitation 90:8, 688-693
CrossRef10
R. N. Barth, E. D. Rodriguez, G. S. Mundinger, A. J. Nam, J. S. Ha, H. Hui-Chou, L. S. Jones, A. Panda, S. T. Shipley, C. B. Drachenberg, D. Kukuruga, S. T. Bartlett. (2011) Vascularized Bone Marrow-Based Immunosuppression Inhibits Rejection of Vascularized Composite Allografts in Nonhuman Primates. American Journal of Transplantation 11:7, 1407-1416
CrossRef11
Oren Z. Lerman, Nicholas Haddock, River M. Elliott, Abtin Foroohar, L. Scott Levin. (2011) Microsurgery of the Upper Extremity. The Journal of Hand Surgery 36:6, 1092-1103
CrossRef12
P. C. Cavadas, J. Ibáñez, A. Thione, L. Alfaro. (2011) Bilateral Trans-humeral Arm Transplantation: Result at 2 Years. American Journal of Transplantation 11:5, 1085-1090
CrossRef13
Yur-Ren Kuo, Chien-Chang Chen, Hsiang-Shun Shih, Shigeru Goto, Chong-Wei Huang, Chun-Ting Wang, Chao-Long Chen, Fu-Chan Wei. (2011) Prolongation of Composite Tissue Allotransplant Survival by Treatment with Bone Marrow Mesenchymal Stem Cells Is Correlated with T-Cell Regulation in a Swine Hind-Limb Model. Plastic and Reconstructive Surgery 127:2, 569-579
CrossRef14
Chirag V. Soni, John H. Barker, Sathnur B. Pushpakumar, L. Allen Furr, Michael Cunningham, Joseph C. Banis, Johannes Frank. (2010) Psychosocial considerations in facial transplantation. Burns 36:7, 959-964
CrossRef15
Keiichi Muramatsu, Hidetoyo Kato, Yuichiro Yoshida, Atsushi Moriya, Toshihiko Taguchi. (2010) Myeloablative Irradiation and Granulocyte Colony-Stimulating Factor Prolong the Survival of Chimeric Limb Allografts in a Rodent Model. Plastic and Reconstructive Surgery 126:1, 53-60
CrossRef16
Diane Perpich. (2010) Vulnerability and the Ethics of Facial Tissue Transplantation. Journal of Bioethical Inquiry 7:2, 173-185
CrossRef17
Thomas H. Tung. (2010) Tacrolimus (FK506): Safety and Applications in Reconstructive Surgery. HAND 5:1, 1-8
CrossRef18
Kevin C. Chung, Takashi Oda, Daniel Saddawi-Konefka, Melissa J. Shauver. (2010) An Economic Analysis of Hand Transplantation in the United States. Plastic and Reconstructive Surgery 125:2, 589-598
CrossRef19
Vijay S. Gorantla, Stefan Schneeberger, W.P. Andrew Lee. 2010. Principles of Hand Transplantation. , 729-736.
CrossRef20
Wei-Chao Huang, Jeng-Yee Lin, Christopher Glenn Wallace, Wen-Yu Chuang, Fu-Chan Wei, Shuen-Kuei Liao. (2010) Vascularized bone grafts within composite tissue allotransplants can auto-create tolerance via mixed chimerism with partial myeloablative conditioning: an experimental study in rats. Plastic and Reconstructive Surgery1
CrossRef21
Rolf N. Barth, Arthur J. Nam, Matthew G. Stanwix, Debra Kukuruga, Cinthia I. Drachenberg, Rachel Bluebond-Langner, Helen Hui-Chou, Steven T. Shipley, Stephen T. Bartlett, Eduardo D. Rodriguez. (2009) Prolonged Survival of Composite Facial Allografts in Non-Human Primates Associated With Posttransplant Lymphoproliferative Disorder. Transplantation 88:11, 1242-1250
CrossRef22
Susumu Tamai. (2009) History of Microsurgery. Plastic and Reconstructive Surgery 124, e282-e294
CrossRef23
Keiichi Muramatsu, Ryutaro Kuriyama, Toshihiko Taguchi. (2009) Intragraft Chimerism Following Composite Tissue Allograft. Journal of Surgical Research 157:1, 129-135
CrossRef24
David B. Hom, Gordon H. Sun, Ravindhra G. Elluru. (2009) A contemporary review of wound healing in otolaryngology: Current state and future promise. The Laryngoscope 119:11, 2099-2110
CrossRef25
Yur-Ren Kuo, Shigeru Goto, Hsiang-Shun Shih, Feng-Sheng Wang, Chien-Chih Lin, Chun-Ting Wang, Eng-Yen Huang, Chao-Long Chen, Fu-Chan Wei, Xin Xiao Zheng, W.P Andrew Lee. (2009) Mesenchymal Stem Cells Prolong Composite Tissue Allotransplant Survival in a Swine Model. Transplantation 87:12, 1769-1777
CrossRef26
Yur-Ren Kuo, Chong-Wei Huang, Shigeru Goto, Chun-Ting Wang, Li-Wen Hsu, Yu-Chun Lin, Kuender D. Yang, Chao-Long Chen, W.P. Andrew Lee. (2009) Alloantigen-Pulsed Host Dendritic Cells Induce T-Cell Regulation and Prolong Allograft Survival in a Rat Model of Hindlimb Allotransplantation. Journal of Surgical Research 153:2, 317-325
CrossRef27
David W. Mathes, Robert Schlenker, Emilia Ploplys, Nicholas Vedder. (2009) A Survey of North American Hand Surgeons on Their Current Attitudes Toward Hand Transplantation. The Journal of Hand Surgery 34:5, 808-814.e2
CrossRef28
Jean-François Chabas, Olivier Alluin, Guillaume Rao, Stéphane Garcia, Marie-Noëlle Lavaut, Régis Legré, Guy Magalon, Tanguy Marqueste, François Feron, Patrick Decherchi. (2009) FK506 Induces Changes in Muscle Properties and Promotes Metabosensitive Nerve Fiber Regeneration. Journal of Neurotrauma 26:1, 97-108
CrossRef29
Kadiyala V. Ravindra, Joseph F. Buell, Christina L. Kaufman, Brenda Blair, Michael Marvin, Ravi Nagubandi, Warren C. Breidenbach. (2008) Hand transplantation in the United States: Experience with 3 patients. Surgery 144:4, 638-644
CrossRef30
Keiichi Muramatsu, Ryutaro Kuriyama, Song You-Xin, Takahiro Hashimoto, Tsunemitsu Matsunaga, Toshihiko Taguchi. (2008) Chimerism studies as an approach for the induction of tolerance to extremity allografts. Journal of Plastic, Reconstructive & Aesthetic Surgery 61:9, 1009-1015
CrossRef31
Luis Landin, Pedro C. Cavadas, Emilio Gonzalez, Jose C. Rodriguez, Araceli Caballero. (2008) Functional outcome after facial allograft transplantation in rats. Journal of Plastic, Reconstructive & Aesthetic Surgery 61:9, 1034-1043
CrossRef32
Warren C. Breidenbach, N. Ruben Gonzales, Christina L. Kaufman, Martin Klapheke, Gordon R. Tobin, Vijay S. Gorantla. (2008) Outcomes of the First 2 American Hand Transplants at 8 and 6 Years Posttransplant. The Journal of Hand Surgery 33:7, 1039-1047
CrossRef33
Bruce Swearingen, Kadiyala Ravindra, Hong Xu, Shengli Wu, Warren C. Breidenbach, Suzanne T. Ildstad. (2008) Science of Composite Tissue Allotransplantation. Transplantation 86:5, 627-635
CrossRef34
Palmina Petruzzo, Marco Lanzetta, Jean Michel Dubernard, Raimund Margreiter, Frédéric Schuind, Warren Breidenbach, Roberta Nolli, Stephan Schneeberger, Carlo van Holder, Christina Kaufman, Jerzy Jablecki, Luis Landin, Pedro Cavadas. (2008) The International Registry on Hand and Composite Tissue Transplantation. Transplantation 86:4, 487-492
CrossRef35
Chunlei Nie, Daping Yang, Ning Li, Guofeng Liu, Tiefang Guo. (2008) Establishing a New Orthotopic Composite Hemiface/Calvaria Transplantation Model in Rabbits. Plastic and Reconstructive Surgery 122:2, 410-418
CrossRef36
Iain S. Whitaker, Eileen M. Duggan, Rita R. Alloway, Charlie Brown, Sean McGuire, E. Steve Woodle, Eugene C. Hsiao, Claudio Maldonado, Joseph C. Banis, John H. Barker. (2008) Composite tissue allotransplantation: a review of relevant immunological issues for plastic surgeons. Journal of Plastic, Reconstructive & Aesthetic Surgery 61:5, 481-492
CrossRef37
Brian Rinker, Xiangdong D. Cui, Michael L. Cibull, Betsy F. Fink, Dayong Y. Gao, Henry C. Vasconez. (2008) Cryopreservation of Composite Tissue Transplants. HAND 3:1, 17-23
CrossRef38
S. Schneeberger, V. S. Gorantla, R. P. van Riet, M. Lanzetta, P. Vereecken, C. van Holder, S. Rorive, M. Remmelink, A. Le Moine, D. Abramowicz, B. Zelger, C. L. Kaufman, W. C. Breidenbach, R. Margreiter, F. Schuind. (2008) Atypical Acute Rejection After Hand Transplantation. American Journal of Transplantation 8:3, 688-696
CrossRef39
Dalibor Vasilic, Christopher C. Reynolds, Michael Cunningham, Allen Furr, Barckley Storey, Joseph C. Banis, Osborne Wiggins, Claudio Maldonado, Rita R. Alloway, Moshe Kon, John H. Barker. (2008) Plastic Surgeon’s Risk Acceptance in Facial Transplantation. Plastic and Reconstructive Surgery 121:3, 41e-48e
CrossRef40
Ryosuke Ikeguchi, Justin M. Sacks, Jignesh V. Unadkat, Mario Solari, Elaine K. Horibe, Angus W. Thomson, Andrew W. P. Lee, Maryam Feili-Hariri. (2008) Long-Term Survival of Limb Allografts Induced by Pharmacologically Conditioned, Donor Alloantigen-Pulsed Dendritic Cells Without Maintenance Immunosuppression. Transplantation 85:2, 237-246
CrossRef41
Justin M. Sacks, Yur-Ren Kuo, Aurele Taieb, Jeremy Breitinger, Vu T. Nguyen, Angus W. Thomson, Maryam Feili-Hariri, W P. Andrew Lee. (2008) Prolongation of Composite Tissue Allograft Survival by Immature Recipient Dendritic Cells Pulsed with Donor Antigen and Transient Low-Dose Immunosuppression. Plastic and Reconstructive Surgery 121:1, 37-49
CrossRef42
John H. Barker, Charles S. Brown, Michael Cunningham, Osborne Wiggins, Allen Furr, Claudio Maldonado, Joseph C. Banis. (2008) Ethical Considerations in Human Facial Tissue Allotransplantation. Annals of Plastic Surgery 60:1, 103-109
CrossRef43
Keiichi Muramatsu, Ryutaro Kuriyama, Toshihiko Taguchi. (2008) Repopulation of donor cells from the recipient following extremity graft: Studies using the LACZ transgenic rat. Microsurgery 28:4, 279-284
CrossRef44
X CUI, D GAO, B FINK, H VASCONEZ, B RINKER. (2007) Cryopreservation of composite tissues and transplantation: Preliminary studies
. Cryobiology 55:3, 295-304
CrossRef45
Marco Lanzetta, Palmina Petruzzo, Jean Michel Dubernard, Raimund Margreiter, Frederic Schuind, Warren Breidenbach, Roberta Nolli, Stephan Schneeberger, Carlo van Holder, Vijay S. Gorantla, Guoxian Pei, Jinmin Zhao, Xinying Zhang. (2007) Second Report (1998–2006) of the International Registry of Hand and Composite Tissue Transplantation. Transplant Immunology 18:1, 1-6
CrossRef46
S. Schneeberger, M. Ninkovic, M. Gabl, M. Ninkovic, H. Hussl, M. Rieger, W. Loescher, B. Zelger, G. Brandacher, H. Bonatti, T. Hautz, C. Boesmueller, H. Piza-Katzer, R. Margreiter. (2007) First Forearm Transplantation: Outcome at 3 Years. American Journal of Transplantation 7:7, 1753-1762
CrossRef47
Keiichi Muramatsu, Hidenori Suzuki, Song You-Xin, Takahiro Hashimoto, Tsunemitsu Matsunaga, Toshihiko Taguchi. (2007) Donor Cell Repopulation of Whole-Limb Allografts in the Rat: Detection with Green Fluorescent Protein. Plastic and Reconstructive Surgery 120:1, 100-107
CrossRef48
Michael Diefenbeck, Frithjof Wagner, Martin H. Kirschner, Andreas Nerlich, Thomas Mückley, Gunther O. Hofmann. (2007) Outcome of allogeneic vascularized knee transplants. Transplant International 20:5, 410-418
CrossRef49
Gordon R. Tobin, Warren C. Breidenbach, Diane J. Pidwell, Suzanne T. Ildstad, Kadiyala V. Ravindra. (2007) Transplantation of the Hand, Face, and Composite Structures: Evolution and Current Status. Clinics in Plastic Surgery 34:2, 271-278
CrossRef50
Maria Siemionow, Galip Agaoglu. (2007) Tissue Transplantation in Plastic Surgery. Clinics in Plastic Surgery 34:2, 251-269
CrossRef51
John H. Barker, Niki Stamos, Allen Furr, Sean McGuire, Michael Cunningham, Osborne Wiggins, Charles S. Brown, Brian Gander, Claudio Maldonado, Joseph C. Banis. (2007) Research and Events Leading to Facial Transplantation. Clinics in Plastic Surgery 34:2, 233-250
CrossRef52
Jerzy Jabłecki, Leszek Kaczmarzyk, Dariusz Patrzałek, Adam Domanasiewicz, Maciej Paruzel, Adam Chełmoński, Janusz Kaczmarzyk. (2007) First Polish Hand Allograft - 6-Month Report. Polish Journal of Surgery 79:3, 232-238
CrossRef53
Julio A. Clavijo-Alvarez, Giselle G. Hamad, Aurèle Taieb, W.P. Andrew Lee. (2007) Pharmacologic Approaches to Composite Tissue Allograft. The Journal of Hand Surgery 32:1, 104-118
CrossRef54
Brian Gander, Charles S. Brown, Dalibor Vasilic, Allen Furr, Joseph C. Banis, Michael Cunningham, Osborne Wiggins, Claudio Maldonado, Iain Whitaker, Gustavo Perez-Abadia, Johannes M. Frank, John H. Barker. (2006) Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery. Transplant International 19:11, 868-880
CrossRef55
Cristina Aubá, Bernardo Hontanilla, Juan Arcocha, Óscar Gorría. (2006) Peripheral nerve regeneration through allografts compared with autografts in FK506-treated monkeys. Journal of Neurosurgery 105:4, 602-609
CrossRef56
Bradford L. Cottrell, Gustavo Perez-Abadia, Stephen M. Onifer, David S. Magnuson, Darlene A. Burke, Federico V. Grossi, Cedric G. Francois, John H. Barker, Claudio Maldonado. (2006) Neuroregeneration in Composite Tissue Allografts: Effect of Low-Dose FK506 and Mycophenolate Mofetil Immunotherapy. Plastic and Reconstructive Surgery 118:3, 615-623
CrossRef57
M. Diefenbeck, F. Wagner, M. H. Kirschner, A. Nerlich, T. Muckley, G. O. Hofmann. (2006) Management of acute rejection 2 years after allogeneic vascularized knee joint transplantation. Transplant International 19:7, 604-606
CrossRef58
Bernardo Hontanilla, Cristina Aub??, Juan Arcocha, Oscar Gorr??a. (2006) Nerve Regeneration through Nerve Autografts and Cold Preserved Allografts using Tacrolimus (FK506) in a Facial Paralysis Model: A Topographical and Neurophysiological Study in Monkeys. Neurosurgery 58:4, 768-779
CrossRef59
S. Schneeberger, M. Ninkovic, H. Piza-Katzer, M. Gabl, H. Hussl, M. Rieger, W. Loescher, B. Zelger, G. Brandacher, M. Ninkovic, H. Bonatti, C. Boesmueller, W. Mark, R. Margreiter. (2006) Status 5 Years after Bilateral Hand Transplantation. American Journal of Transplantation 6:4, 834-841
CrossRef60
Maria Siemionow, Sakir Unal, Galip Agaoglu, Alper Sari. (2006) A Cadaver Study in Preparation for Facial Allograft Transplantation in Humans: Part I. What Are Alternative Sources for Total Facial Defect Coverage?. Plastic and Reconstructive Surgery 117:3, 864-872
CrossRef61
Selahattin Ozmen, Betul G. Ulusal, Ali E. Ulusal, Dariusz Izycki, Maria Siemionow. (2006) Composite Vascularized Skin/Bone Transplantation Models for Bone Marrow-Based Tolerance Studies. Annals of Plastic Surgery 56:3, 295-300
CrossRef62
Simon E. Brill, Alex Clarke, David M. Veale, Peter E.M. Butler. (2006) Psychological management and body image issues in facial transplantation. Body Image 3:1, 1-15
CrossRef63
Chad R. Gordon, Jamal Nazzal, Santiago A. Lozano-Calderan, Sang Gil P. Lee, W. P. Andrew Lee, Maria Siemionow, Martha S. Matthews, Charles W. Hewitt. (2006) From experimental rat hindlimb to clinical face composite tissue allotransplantation: Historical background and current status. Microsurgery 26:8, 566-572
CrossRef64
Pascal Brouha, Deepak Naidu, Michael Cunningham, Allen Furr, Ramsey Majzoub, Federico V. Grossi, Cedric G. Francois, Claudio Maldonado, Joseph C. Banis, Serge Martinez, Gustavo Perez-Abadia, Osborne Wiggins, Moshe Kon, John H. Barker. (2006) Risk acceptance in composite-tissue allotransplantation reconstructive procedures. Microsurgery 26:3, 144-149
CrossRef65
Maria Siemionow, Sakir Unal. (2005) Strategies for Tolerance Induction in Nonhuman Primates. Annals of Plastic Surgery 55:5, 545-553
CrossRef66
Stefan Schneeberger, Stefano Lucchina, Marco Lanzetta, Gerald Brandacher, Claudia B??sm??ller, Wolfgang Steurer, Fausto Baldanti, Clara Dezza, Raimund Margreiter, Hugo Bonatti. (2005) Cytomegalovirus-Related Complications in Human Hand Transplantation. Transplantation 80:4, 441-447
CrossRef67
Claire L.F. Temple, Douglas C. Ross. (2005) Scalp and Forehead Reconstruction. Clinics in Plastic Surgery 32:3, 377-390
CrossRef68
Maria Siemionow, Galip Agaoglu. (2005) Allotransplantation of the Face: How Close Are We?. Clinics in Plastic Surgery 32:3, 401-409
CrossRef69
Robert E Babine, J Ernest Villafranca, Bruce G Gold. (2005) FKBP immunophilin patents for neurological disorders. Expert Opinion on Therapeutic Patents 15:5, 555-573
CrossRef70
Marco Lanzetta, Palmina Petruzzo, Raimund Margreiter, Jean Michel Dubernard, Frederic Schuind, Warren Breidenbach, Stefano Lucchina, Stefan Schneeberger, Carlo van Holder, Darla Granger, Guoxian Pei, Jinmin Zhao, Xinying Zhang. (2005) The International Registry on Hand and Composite Tissue Transplantation. Transplantation 79:9, 1210-1214
CrossRef71
Bruce G. Gold, David M. Armistead, Min-Sheng Wang. (2005) Non-FK506-binding protein-12 neuroimmunophilin ligands increase neurite elongation and accelerate nerve regeneration. Journal of Neuroscience Research 80:1, 56-65
CrossRef72
John N. Jensen, Michael J. Brenner, Thomas H. Tung, Daniel A. Hunter, Susan E. Mackinnon. (2005) Effect of FK506 on Peripheral Nerve Regeneration Through Long Grafts in Inbred Swine. Annals of Plastic Surgery 54:4, 420-427
CrossRef73
G.R. Tobin, W.C. Breidenbach, M.M. Klapheke, F.R. Bentley, D.J. Pidwell, P.D. Simmons. (2005) Ethical Considerations in the Early Composite Tissue Allograft Experience: A Review of the Louisville Ethics Program. Transplantation Proceedings 37:2, 1392-1395
CrossRef74
You-Xin Song, Keiichi Muramatsu, Yoko Kurokawa, Toshihiko Taguchi. (2005) Prolonged survival of rat hindlimb allografts following short-course FK506 and mycophenolate mofetil combination therapy. Microsurgery 25:4, 353-359
CrossRef75
Keiichi Muramatsu, Yoko Kurokawa, Song You-Xin, Allen T. Bishop, Kazuteru Doi. (2005) Cell traffic between donor and recipient following rat limb allograft. Journal of Orthopaedic Research 23:1, 181-187
CrossRef76
Hebe D Kvernmo, Vijay S Gorantla, Ruben N Gonzalez, Warren C Breidenbach. (2005) Hand transplantation. Acta Orthopaedica 76:1, 14-27
CrossRef77
Steffen Baumeister, Nina Ofer, Christian Kleist, Peter Terne, Gerhard Opelz, Martha Maria Gebhard, G??nter Germann, Christoph Heitmann. (2004) Reduction of Skeletal Muscle Injury in Composite Tissue Allotransplantation by Heat Stress Preconditioning. Plastic and Reconstructive Surgery 114:7, 1832-1841
CrossRef78
Yavuz Demir, Selahattin Ozmen, Aleksandra Klimczak, Abir Lal Mukherjee, Maria Siemionow. (2004) Tolerance Induction in Composite Facial Allograft Transplantation in the Rat Model. Plastic and Reconstructive Surgery 114:7, 1790-1801
CrossRef79
Esther Udina, Francisco J. Rodr
guez, Enrique Verd
CrossRef80
Bruce G. Gold, Jan Voda, Xiaolin Yu, Gabriel McKeon, Dennis N. Bourdette. (2004) FK506 and a nonimmunosuppressant derivative reduce axonal and myelin damage in experimental autoimmune encephalomyelitis: Neuroimmunophilin ligand-mediated neuroprotection in a model of multiple sclerosis. Journal of Neuroscience Research 77:3, 367-377
CrossRef81
Esther Udina, Bruce G. Gold, Xavier Navarro. (2004) Comparison of continuous and discontinuous FK506 administration on autograft or allograft repair of sciatic nerve resection. Muscle & Nerve 29:6, 812-822
CrossRef82
James Robert Wendt, Tom Ulich, P. Nagesh Rao. (2004) Long-Term Survival of Human Skin Allografts in Patients with Immunosuppression. Plastic and Reconstructive Surgery 113:5, 1347-1354
CrossRef83
Xiao-Fei Zheng, Guo-Xian Pei, Yu-Rong Qiu, Li-Jun Zhu, Li-Qiang Gu. (2004) Serial monitoring of immunological parameters following human hand transplant. Clinical Transplantation 18:2, 119-123
CrossRef84
Osborne P. Wiggins, John H. Barker, Serge Martinez, Marieke Vossen, Claudio Maldonado, Federico V. Grossi, Cedric G. Francois, Michael Cunningham, Gustavo Perez-Abadia, Moshe Kon, Joseph C. Banis. (2004) On the Ethics of Facial Transplantation Research. The American Journal of Bioethics 4:3, 1-12
CrossRef85
Kagan Ozer, Dariusz Izycki, Maciej Zielinski, Maria Siemionow. (2004) Development of donor-specific chimerism and tolerance in composite tissue allografts under ??-T-cell receptor monoclonal antibody and cyclosporine a treatment protocols. Microsurgery 24:3, 248-254
CrossRef86
Karen J. Maschke, Eric Trump. (2004) Facial Transplantation Research: A Need for Additional Deliberation. The American Journal of Bioethics 4:3, 33-35
CrossRef87
Gustavo Perez-Abadia, Luis Laurentin-Perez, Vijay S. Gorantla, Cedric G. Francois, Marieke Vossen, Pascal C.R. Brouha, Haldun I. Orhun, Gary L. Anderson, Claudio Maldonado, Diane J. Pidwell, Warren C. Breidenbach, John H. Barker. (2003) Low-dose immunosuppression in a rat hind-limb transplantation model. Transplant International 16:12, 835-842
CrossRef88
Yuki Sato, Takashi Ajiki, Seiichiro Inoue, Yoji Hakamata, Takashi Murakami, Takashi Kaneko, Masafumi Takahashi, Eiji Kobayashi. (2003) A novel gene therapy to the graft organ by a rapid injection of naked DNA I: long-lasting gene expression in a rat model of limb transplantation. Transplantation 76:9, 1294-1298
CrossRef89
Waldemar L. Olszewski, Bozena Interewicz, Michal Maksymowicz, Marek Durlik. (2003) Biological Aspects of Limb Transplantation: I. Migration of Transplanted Bone Marrow Cells into Recipient. Plastic and Reconstructive Surgery 112:6, 1628-1635
CrossRef90
Palmina Petruzzo, Jean Pierre Revillard, Jean Kanitakis, Marco Lanzetta, Nadey S Hakim, Nicole Lefrancois, Earl Owen, Jean Michel Dubernard. (2003) First human double hand transplantation: efficacy of a conventional immunosuppressive protocol. Clinical Transplantation 17:5, 455-460
CrossRef91
Jean Kanitakis, Denis Jullien, Palmina Petruzzo, Nadey Hakim, Alain Claudy, Jean-Pierre Revillard, Earl Owen, Jean-Michel Dubernard. (2003) Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation 76:4, 688-693
CrossRef92
Jean Michel Dubernard, Palmina Petruzzo, Marco Lanzetta, Helen Parmentier, Xavier Martin, Marwan Dawahra, Nadey S Hakim, Earl Owen. (2003) Functional Results of the First Human Double-Hand Transplantation. Annals of Surgery 238:1, 128-136
CrossRef93
David M Levi, Andreas G Tzakis, Tomoaki Kato, Juan Madariaga, Naveen K Mittal, Jose Nery, Seigo Nishida, Phillip Ruiz. (2003) Transplantation of the abdominal wall. The Lancet 361:9376, 2173-2176
CrossRef94
Andreas S. L??bbe. (2003) SUCCESSFUL HAND TRANSPLANTATION OR TOO EARLY TO TELL?. Transplantation 75:11, 1916-1917
CrossRef95
Maria Siemionow, Betul Gozel-Ulusal, Ali Engin Ulusal, Selahattin Ozmen, Dariusz Izycki, James E. Zins. (2003) Functional tolerance following face transplantation in the rat. Transplantation 75:9, 1607-1609
CrossRef96
Takashi Ajiki, Masafumi Takahashi, Seiichiro Inoue, Yasunaru Sakuma, Shigetaka Oyama, Takashi Kaneko, Yoji Hakamata, Takashi Murakami, Akihiro Kume, Yusei Kariya, Yuichi Hoshino, Eiji Kobayashi. (2003) Generation of donor hematolymphoid cells after rat-limb composite grafting. Transplantation 75:5, 631-636
CrossRef97
Toru Tsuchida, Teiji Kato, Makio Yamaga, Kenshiro Ikebe, Yasunari Oniki, Hiroki Irie, Katsumasa Takagi. (2003) The effect of perfusion with UW solution on the skeletal muscle and vascular endothelial exocrine function in rat hindlimbs. Journal of Surgical Research 110:1, 266-271
CrossRef98
Kohei Kanaya, Yoshihiko Tsuchida, Manabu Inobe, Masaaki Murakami, Toshiaki Hirose, Shigeyuki Kon, Satoshi Kawaguchi, Takuro Wada, Toshihiko Yamashita, Seiichi Ishii, Toshimitsu Uede. (2003) Combined gene therapy with adenovirus vectors containing CTLA4Ig and CD40Ig prolongs survival of composite tissue allografts in rat model. Transplantation 75:3, 275-281
CrossRef99
Fran??ois Petit, Alicia B. Minns, Jean-Michel Dubernard, Shehan Hettiaratchy, W. P. Andrew Lee. (2003) Composite Tissue Allotransplantation and Reconstructive Surgery. Annals of Surgery 237:1, 19-25
CrossRef100
David W. Mathes, Mark A. Randolph, Mario G. Solari, Jamal A. Nazzal, G. Petur Nielsen, J. Scott Arn, David H. Sachs, W. P. Andrew Lee. (2003) Split tolerance to a composite tissue allograft in a swine model. Transplantation 75:1, 25-31
CrossRef101
Kagan Ozer, Ramadan Oke, Raffi Gurunluoglu, Maciej Zielinski, Dariusz Izycki, Rita Prajapati, Maria Siemionow. (2003) Induction of tolerance to hind limb allografts in rats receiving cyclosporine A and antilymphocyte serum: effect of duration of the treatment. Transplantation 75:1, 31-36
CrossRef102
Darla K. Granger, Warren C. Briedenbach, Diane J. Pidwell, Jon W. Jones, Lee Ann Baxter-Lowe, Christina L. Kaufman. (2002) Lack of donor hyporesponsiveness and donor chimerism after clinical transplantation of the hand1. Transplantation 74:11, 1624-1630
CrossRef103
Maria Siemionow, Turgut Ortak, Dariusz Izycki, Ramadan Oke, Brian Cunningham, Rita Prajapati, James E. Zins. (2002) Induction of tolerance in composite-tissue allografts. Transplantation 74:9, 1211-1217
CrossRef104
Luis Eduardo Berm?? dez, Alida Santamar??a, Tomas Romero, Diego Fernando Calder?? n. (2002) EXPERIMENTAL MODEL OF FACIAL TRANSPLANT. Plastic and Reconstructive Surgery 110:5, 1374-1375
CrossRef105
V. C. Lees, S. J. McCabe. (2002) The rationale for hand transplantation.. Transplantation 74:6, 749-753
CrossRef106
Esther Udina, Dolores Ceballos, Enrique Verd
CrossRef107
Raimund Margreiter, G. Brandacher, M. Ninkovic, W. Steurer, A. Kreczy, S. Schneeberger. (2002) A double-hand transplant can be worth the effort!. Transplantation 74:1, 85-90
CrossRef108
Olawale A.R. Sulaiman, Jan Voda, Bruce G. Gold, Tessa Gordon. (2002) FK506 Increases Peripheral Nerve Regeneration after Chronic Axotomy but Not after Chronic Schwann Cell Denervation. Experimental Neurology 175:1, 127-137
CrossRef109
John H. Barker, Cedric G. Francois, Johannes M. Frank, Claudio Maldonado. (2002) Composite tissue allotransplantation. Transplantation 73:5, 832-835
CrossRef110
Michael L. Conforti, Nadine P. Connor, Dennis M. Heisey, Gregory K. Hartig. (2002) Evaluation of Performance Characteristics of the Medicinal Leech (Hirudo medicinalis) for the Treatment of Venous Congestion. Plastic and Reconstructive Surgery 109:1, 228-235
CrossRef111
W. P. Andrew Lee, Peter E. M. Butler, Mark A. Randolph, Michael J. Yaremchuk. (2001) Donor Modification Leads to Prolonged Survival of Limb Allografts. Plastic and Reconstructive Surgery 108:5, 1235-1241
CrossRef112
Robert D. Foster, Nancy L. Ascher, Timothy H. McCalmont, Michael Neipp, James P. Anthony, Stephen J. Mathes. (2001) MIXED ALLOGENEIC CHIMERISM AS A RELIABLE MODEL FOR COMPOSITE TISSUE ALLOGRAFT TOLERANCE INDUCTION ACROSS MAJOR AND MINOR HISTOCOMPATIBILITY BARRIERS1. Transplantation 72:5, 791-797
CrossRef113
Simone R
CrossRef114
Xavier Navarro, Esther Udina, Dolores Ceballos, Bruce G. Gold. (2001) Effects of FK506 on nerve regeneration and reinnervation after graft or tube repair of long nerve gaps. Muscle & Nerve 24:7, 905-915
CrossRef115
Monaco, Anthony P., . (2001) Transplantation of the Larynx — A Case Report That Speaks for Itself. New England Journal of Medicine 344:22, 1712-1714
Full Text116
N. C. Hatrick, M. A. Tonkin. (2001) Hand transplantation: A current perspective. ANZ Journal of Surgery 71:4, 245-251
CrossRef117
Brian R. Kann, Charles W. Hewitt. (2001) Composite Tissue (Hand) Allotransplantation: Are We Ready?. Plastic and Reconstructive Surgery 107:4, 1060-1065
CrossRef118
Bruce G. Gold. (2001) Tissue Engineering of Peripheral Nerves: A Comparison of Venous and Acellular Muscle Grafts with Cultured Schwann Cells by Hisham Fansa, M.D. Gerburg Keilhoff, Ph.D., Gerald Wolf, Ph.D., Wolfgang Schneider, M.D., Ph.D.. Plastic and Reconstructive Surgery 107:2, 495-496
CrossRef119
(2001) Successful Hand Transplantation — One-Year Follow-up. New England Journal of Medicine 344:1, 65-65
Full Text120
Bruce G Gold. (2000) Neuroimmunophilin ligands: evaluation of their therapeutic potential for the treatment of neurological disorders. Expert Opinion on Investigational Drugs 9:10, 2331-2342
CrossRef121
Herndon, James H., . (2000) Composite-Tissue Transplantation — A New Frontier. New England Journal of Medicine 343:7, 503-505
Full Text122
Brian R. Kann, David W. Furnas, Charles W. Hewitt. (2000) Past, present, and future research in the field of composite tissue allotransplantation. Microsurgery 20:8, 393-399
CrossRef123
E. Tuncay
CrossRef124
Cedric G. Francois, Warren C. Breidenbach, Claudio Maldonado, Thanos P. Kakoulidis, Anne Hodges, Jean-Michel Dubernard, Earl Owen, Guoxain Pei, Xiaoping Ren, John H. Barker. (2000) Hand transplantation: Comparisons and observations of the first four clinical cases. Microsurgery 20:8, 360-371
CrossRef125
Vijay S. Gorantla, John H. Barker, Jon W. Jones, Kaustubha Prabhune, Claudio Maldonado, Darla K. Granger. (2000) Immunosuppressive agents in transplantation: Mechanisms of action and current anti-rejection strategies. Microsurgery 20:8, 420-429
CrossRef126
Scott A. Gruber, Mansour V. Shirbacheh, Jon W. Jones, John H. Barker, Warren C. Breidenbach. (2000) Local drug delivery to composite tissue allografts. Microsurgery 20:8, 407-411
CrossRef
