Cellular Therapies in Vascularized Composite Allograft

The preclinical experimental models of donor bone marrow transplantation (BMT) for chimerism induction have rapidly developed in the past years. The presence of mixed chimerism in solid organs and in vascularized composite allograft (VCA) transplantations is on focus as tolerance-inducing strategy for allograft survival with minimal or without long-lasting immunosuppression allowing for widespread application in the clinic. In this Chapter we summarize our experience of cellular therapies with donor hematopoietic cells for chimerism induction in VCA. We introduce different alternative methods of bone marrow cell (BMC) delivery including: (1) standard intravenous, (2) intraosseous, and into immunoprivileged compartments (3) under kidney capsule, (4) into testis, and (5) intrathecal infusion, for chimerism induction. The efficacy of donor BMT for chimerism induction was tested on limb, vascularised skin and face transplant experimental models.