Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression.

Over 150 composite tissue allotransplantations have been performed to date with highly encouraging outcomes.1 In the combined American and European experience, graft survival is greater than 90%. However, 1 patient died from sepsis after combined hand and face transplantation and another developed avascular hip necrosis, emphasizing the importance of minimizing immunosuppression after such non-life-saving transplants. Donor bone marrow (BM) infusion has been attempted in selected cases of solid organ transplantation with the goal of reducing overall immunosuppression.2–7 After successful experimental trial of a similar strategy in a large animal composite tissue allotransplantation model,8 we implemented the treatment protocol in 5 upper-extremity transplant recipients. The 1-year results reported here suggest that the protocol is well tolerated and enables allograft survival with low-dose tacrolimus monotherapy.