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• W1488572751 abstract "Although organ and tissue transplantation has been a fantasy for centuries, the epidemic of discovery in transplantation has taken place primarily during the past 55 years. In 1954, Dr J. Murray was presented with the unique opportunity to transplant a human kidney between identical twins without facing the challenges of acute or chronic allograft rejection as well as side effects of long-term immunosuppression (1, 2). Adding to scientific knowledge through basic research helped us to perform complex vascularized composite allotransplants (VCA) like the hand and face today and vascularized tissues recovered from a different individual will soon be extended to all reconstructive transplant procedures currently requiring autologous tissues (3-5). The development of novel surgical techniques and the discovery of potent immunosuppressive drugs in the second half of the 20th century propelled the clinical development of organ transplantation(6). The combination of corticosteroids and azathioprine, which was the primary immunosuppressive regimen, used from the late 1960’s until 1980 culminated in one-year survival rates of only 40% 50%. Most notably, the discovery of cyclosporine A and tacrolimus in the 1970’s and 1980’s represented another major milestone in solid organ transplantation resulting in excellent short-term and acceptable long-term survival rates. With current immunosuppressive regimens mainly consisting of the triple combination of corticosteroids, mycophenolate mofetil, and tacrolimus the overall graft and patient survival has improved substantially and reached one-year graft survival rates of 80%-95% leading to consider organ and tissue transplantation as treatment modality of choice for patients with end–stage organ failure or severe tissue defects due to trauma or burn. Despite significant improvements in acute rejection rates, long-term solid organ allograft survival remained unchanged for the last 15 years (7). The major causes for late graft loss include chronic allograft rejection and death with a functioning graft (8, 9). Since the immunologic graft-loss-rate seemed to be highest within the first months after transplantation, it became the rule that heightened immunosuppression is required early, with progressive reduction over time, leading to the definition of three distinct periods of immunosuppression after transplantation: The perioperative “induction period”, where immunosuppressants are initially given at high doses, the “early maintenance period”, which is characterized by progressive taper of the individual drugs, and the “chronic" @default.
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• W1488572751 date "2012-02-24" @default.
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• W1488572751 title "Clinical Immunosuppression in Solid Organ and Composite Tissue Allotransplantation" @default.
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• W1488572751 doi "https://doi.org/10.5772/26896" @default.
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