(See also Overview of the transplant;. For corneal transplantation, corneal transplantation) Composite Transplantation (hand, extremities, face) Composite transplants involve multiple tissues, usually including the skin and soft tissues and sometimes musculoskeletal structures. due to advances in immunosuppressive therapy Many of these methods are possible today. However, the methods are ethically controversial because they do not contribute in general to an extension of life, are very expensive and resource-consuming, and can lead to infections due to morbidity and mortality potentially. The first successful composite transplants were hand transplants. Since then, perhaps up to 10 different structures have been replaced at about 150 patients with different functional success rates. The first hand transplant was performed in the year 1998th Since then, both hands and upper extremities were transplanted. The restoration of hand function varies widely. Some recipients regain sufficient function and sensitivity to perform daily activities. The first face transplant was carried out in the year of 2005. Since 2011, 17 such procedures were made To date, there are no reports of graft failure, but the recipient of the first Gesichtstranplantats died in 2016 .. In face transplants are ethical issues even more prominent than in transplantation of the extremities, because the surgical procedure is extremely demanding and the required immunosuppression exposes the recipient to a significant risk of opportunistic infections. IImmunsuppression consists as a rule of induction therapy (antithymocyte globulin [ATG] or IL-2 receptor blocker), followed by a triple Conservation immunosuppression with a corticosteroid, an anti-proliferative drug (e.g., basiliximab.) And a calcineurin inhibitor (see table: immunosuppressive agents for the treatment of transplant rejection). Sometimes topical creams that calcineurin inhibitors or corticosteroids will contain used. Skin grafts Skin grafts may be autotransplantation allografts skin grafts own skin of the patient is used as a skin graft. Usually split skin grafts are used; for these transplants, a thin layer is cut from the epidermis and dermis and placed on the recipient site. Such grafts are typically used for burns, but also be transplanted to faster healing of small wounds. Because a significant amount remains in body panels at the donor site, the site eventually heals and can be removed again. Full-thickness skin grafts consist of the epidermis and dermis and provide a better appearance and function as a split-thickness skin grafts. However, since the donor site is initially not cure, there must be a loose area of ??redundant skin (z. B. abdominal or chest wall, sometimes scalp) give, so that the site can be sutured. Thus, the full-thickness skin grafting cosmetically sensitive areas reserved (eg. As facial) or areas that require a thicker protective layer of the skin (eg. As hands). Since full-thickness skin grafts are thicker and more vascular, they have a not so high survival rate as split-thickness skin grafts. Skin cells may be grown in culture and are fed back to the patient to cover extensive burns. Alternatively, artificial skin comprising cultured cells or a thin split thickness skin graft also be used on a synthetic underlayer werden.Hautallotransplantate skin allografts use donor skin (typically from cadavers). Hautallotransplantate be performed in patients with extensive burns or so massive skin loss from other causes that the patient does not have enough intact skin that can be made available to the transplant is supplied. Allografts can be used to cover large areas of skin exposed by, thereby reducing fluid and protein losses and ward off invasive infections. Unlike solid organ transplant Hautallotransplantate are ultimately rejected, but the resulting bare areas develop well-circulated granulations on which the autografts of healed bodies grow rapidly. Cartilage Transplantation Cartilage transplantation is performed in children with congenital nasal or ear defects, and in adults with severe injuries or joint destruction (eg. As severe osteoarthritis). Chondrocytes are against rejection resistant, possibly because the sparse cell population is protected in hyaline cartilage tissue from cellular attacks by the cartilaginous matrix around them. Immunosuppression is therefore not indicated. Bone grafting, bone grafts are used for reconstruction of large bone defects is performed (z. B. after massive bone resection with bone cancer). In the receiver, though no viable bone cells from the donor survive, but the remaining matrix of allografts can stimulate the osteoblasts of the recipient for repopulation of the matrix and to generate new bone. Thus the matrix serves as a scaffold for bridging and stabilization of defects is formed by new bone. Leichenallotransplantate are preserved by freezing to reduce the immunogenicity of the bone (at the time of implantation is no longer alive). Treatment with glycerol increases the viability of chondrocytes. After implantation, no immunosuppressive therapy is performed. Although these patients develop HLA antibodies, early follow-up examinations have shown no evidence of degradation of the cartilage. Adrenal own tissue, the treatment of Parkinson’s patients with autografts from the adrenal medulla tissue that is stereotactically introduced into the CNS has led to symptom relief studies. Also allografts by-cortical tissue, especially from fetal donors is discussed. Further, to fetal tissue from the mesencephalon, which is implanted stereotactically in the putamen of Parkinsonian patients, reduce rigidity and bradykinesia the patient. However, given the ethical and political debate about the legality of using fetal human tissue, it is unlikely that a sufficiently large, controlled trial can be conducted, with which the fetal neural transplantation can assess adequately. Xenografts endocrinologically active cells from pigs are being tested. Fetal Thymusimplantate fetal Thymusimplantate that are taken from stillborn children may be able to immune responses in children with thymic aplasia and resulting abnormal development of lymphoid organs to restore (DiGeorge syndrome). Because the recipient is not immunocompetent, immunosuppression is not required; however, it can cause a graft-vs-host disease.


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