Allotransplantation

Allotransplants
Allotransplants
MeSH	D014184
	[edit on Wikidata]

Allotransplant (allo- meaning "other" in Greek) is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor of the same species.^[1] The transplant is called an allograft, allogeneic transplant, or homograft. Most human tissue and organ transplants are allografts.

It is contrasted with autotransplantation (from one part of the body to another in the same person), syngenic transplantation of isografts (grafts transplanted between two genetically identical individuals) and xenotransplantation (from other species).

Allografts can be referred to as "homostatic" if they are biologically inert when transplanted, such as bone and cartilage.^[2]

An immune response against an allograft or xenograft is termed rejection. An allogenic bone marrow transplant can result in an immune attack on the recipient, called graft-versus-host disease.

Procedure

Material is obtained from a donor who is a living person, or a deceased person's body receiving mechanical support or ventilation, or a deceased person's body whose heart stopped beating. Screening for pathology and risk factors for communicable diseases such as HIV and Hepatitis B and C is then conducted.^[3]

In the US, donor tissue must be recovered and processed adhering to the Current Good Tissue Practices rule. In most cases, it is sent to tissue banks for processing and distribution. Each year, Food and Drug Administration regulated and American Association of Tissue Banks-accredited tissue banks distribute 1.5 million bone and tissue allografts.

Transplantable organs and tissues

A variety of organs and tissues can be used for allografts, including:

Anterior cruciate ligament (ACL) repair
Joint reconstruction in the knee and ankle
Meniscal replacement
Reconstruction due to cancer or trauma
Ridge augmentation in dental procedures
Shoulder repair
Spinal fusion
Urological procedures
Skin transplants
Corneal transplants
Heart transplants
Heart valves
Lung transplantation
Intestinal transplantation (isolated small bowel, intestine & liver, multivisceral)
Liver transplants
Kidney transplants
Pancreas transplantation
Islet cell transplantation
Bone marrow transplants
Bone allograft
Ligament or tendon allograft

Laws and regulations

United States

In the US, the Food and Drug Administration (FDA) has regulated human tissue intended for transplants since 1993. In order to ensure the quality of donor tissue and reduce contamination and disease transmission risks, three regulations addressing manufacturing activities associated with human cells, tissues, and cellular and tissue-based products (HCT/Ps) were promulgated in May 2005:

companies producing and distributing HCT/Ps must register with the FDA.
"Donor Eligibility" rule: prescribes criteria for donor eligibility.
"Current Good Tissue Practices" rule: oversees overall processing and distribution practices of each company.

Other transplant options

Autograft, tissue transplanted from one site to another on the same patient. An autograft reduces the risk of rejection but requires a second surgery site, adding pain, risk and possible longer aftercare.
Xenograft, a transplant from another species
Isograft, a transplant from a genetically identical donor, such as an identical twin.
Synthetic and metal implants. Unlike allografts, such grafts do not corporate into the body.

Risks

As with many operations, allotransplantation risks some side effects. A limiting factor in tissue allotransplantation for reconstructive surgery deals with the side effects of immunosuppression (metabolic disorders, malignancies, opportunistic infections) which is a predominant issue. The risk of transmitting infection is high.^[3]

References

^ "None".
^ (W. P. Longmire, J. National Cancer Institute 14, 669: The term homostatic graft might be applied to inert tissues such as bone and cartilage when transferred from one individual to another of the same species; and the term homovital graft might be used in reference to grafts whose cells must continue to grow and reproduce for the graft to be effective after similar transplantation; H. Conway, The Bulletin of the Hong Kong Chinese Medical Association 13, 43: These grafts persist however as homostatic grafts and are completely replaced by host tissues in time.)
^ ^a ^b Petit, F.; Minns, A. B.; Dubernard, J. M.; Hettiaratchy, S.; Lee, W. P. (2003). "Composite Tissue Allotransplantation and Reconstructive Surgery". Annals of Surgery. 237 (1): 19–25. doi:10.1097/00000658-200301000-00004. PMC 1513974. PMID 12496526.

External links

[1]
[2]
Tissue & Tissue Products
OrganDonor.gov (How to register to be a donor in the USA)
Allogeneic stem cell transplantation entry in the public domain NCI Dictionary of Cancer Terms
Allogeneic bone marrow transplantation entry in the public domain NCI Dictionary of Cancer Terms

[1] "None".

[2] (W. P. Longmire, J. National Cancer Institute 14, 669: The term homostatic graft might be applied to inert tissues such as bone and cartilage when transferred from one individual to another of the same species; and the term homovital graft might be used in reference to grafts whose cells must continue to grow and reproduce for the graft to be effective after similar transplantation; H. Conway, The Bulletin of the Hong Kong Chinese Medical Association 13, 43: These grafts persist however as homostatic grafts and are completely replaced by host tissues in time.)

[:0-3] Petit, F.; Minns, A. B.; Dubernard, J. M.; Hettiaratchy, S.; Lee, W. P. (2003). "Composite Tissue Allotransplantation and Reconstructive Surgery". Annals of Surgery. 237 (1): 19–25. doi:10.1097/00000658-200301000-00004. PMC 1513974. PMID 12496526.

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[2]

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