Exploring cell-based tolerance strategies for hand and face transplantation

Madeline Fryer, Johanna Grahammer, Saami Khalifian, Georg J. Furtmüller, W. P.Andrew Lee, Giorgio Raimondi, Gerald Brandacher

Research output: Contribution to journalReview articlepeer-review


Broader clinical application of reconstructive hand and face transplantation is hindered by the need for lifelong immunosuppression for allograft maintenance. In this review, we summarize various cell-based approaches to tolerance induction currently under investigation in both clinical and pre-clinical models to alleviate the need for chronic immunosuppression. These include strategies to induce mixed hematopoietic chimerism, therapy with T and B regulatory cells, regulatory macrophages, tolerogenic dendritic cells, and mesenchymal stem cells. The vascularized, intragraft bone components inherent to reconstructive transplants serve as a continuous source of donor-derived hematopoietic cells, and make hand and face transplants uniquely well suited for cell-based approaches to tolerance that may ultimately tilt the risk-benefit balance for these life-changing, but not life-saving, procedures.

Original languageEnglish (US)
Pages (from-to)1189-1204
Number of pages16
JournalExpert review of clinical immunology
Issue number11
StatePublished - Nov 2 2015


  • mesenchymal stem cell
  • mixed chimerism
  • regulatory B cell
  • regulatory T cell
  • regulatory macrophage
  • tolerance
  • tolerogenic dendritic cell
  • vascularized composite allotransplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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