Mixed Chimerism-Based Regimens in VCA

Amputations and devastating injuries throughout the body can now be reconstructed by transplanting vascularized composite allografts (VCAs) of the extremities, face, penis, scalp, skull, abdominal wall, and even the uterus. While functional and quality of life outcomes have been highly promising, the requirement for, and complications from long-term immunosuppression have predictably been reported in VCA recipients as with solid organ transplantation. Immunologic tolerance represents an alternative strategy to prevent rejection of VCAs without the need for immunosuppression. Clinically, long-term tolerance of allografts without maintenance immunosuppression has been achieved in kidney transplantation patients through the induction of mixed chimerism, whereby both donor and recipient-derived lymphohematopoietic elements co-exist within the recipient. This paper serves to review the currently available evidence from both clinical and experimental studies on mixed chimerism based regimens in VCA. © 2016, Springer International Publishing AG.