New strategies in composite tissue allotransplantation

Over the last two decades, composite tissue allotransplantation (CTA), more recently referred to as vascularized composite allotransplantation (VCA), has become a valid therapeutic and restorative option for patients with severe tissue defects. While functional outcomes are such that recipients' quality of life is significantly improved and in some cases even dramatically enhanced, long-term risks are still difficult to evaluate in a precise fashion. Strategies have been devised, and new ones are being explored, in order to minimize or, if possible, eliminate the need for immunosuppression while keeping rejection under control. Success in these efforts would ultimately tilt the risk versus benefit balance, so that VCA may become widely adopted and a standard therapeutic option. This chapter introduces a brief historical perspective as well as a description of the current state of play within the discipline. It examines emerging challenges and then focuses on novel research avenues and clinical perspectives for the future.