• Iain S Whitaker, Eileen M Duggan, Rita R Alloway, Charlie Brown, Sean McGuire, E Steve Woodle, Eugene C Hsiao, Claudio Maldonado, Joseph C Banis, and John H Barker.
• Department of Surgery, University of Louisville, 511 South Floyd Street, 320 MDR Building, Louisville, KY 40202, USA.
• J Plast Reconstr Aesthet Surg. 2008 Jan 1;61(5):481-92.

BackgroundComposite tissue allotransplantation of hand, facial and other tissues is now a clinical reality. The terminology, treatment principles, drug combinations, dosage schedules and mechanisms of the immunosuppression medications on which contemporary transplant surgery is based are unfamiliar to plastic surgeons and most healthcare providers outside the field of transplantation medicine. With this in mind, the purpose of this manuscript is to provide plastic surgeons with a comprehensive and understandable review of key immunological principles relevant to composite tissue allotransplantation.MethodsWe present an overview of the immunological basis of composite tissue allotransplantation aimed at the plastic surgery readership, based on our own experience plus manuscripts sourced from MEDLINE, EMBASE, text books, ancient manuscripts and illustrations.ResultsIn this manuscript we provide the reader with a brief history of composite tissue allotransplantation (CTA), a concise description of the immunological terminology, treatment approaches, risks associated with immunosuppressive therapy, risk acceptance, and current research avenues relating to contemporary CTA.ConclusionToday, as transplant and reconstructive surgeons join forces to move hand and facial tissue allotransplantation into the clinical arena, it is important that plastic surgeons have an understanding of the major immunological principles upon which this new treatment is based.

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