Physicians and Researchers Convene to Discuss Transplant Issues

Tissue Allotransplantation

Date: 6/15/2000

(NewsRx.com) -- Physicians and researchers from around the globe convened at Jewish Hospital in Louisville, Kentucky, during the Second International Symposium on Composite Tissue Allotransplantation (CTA - multiple tissue transplant), May 18-19, 2000.

CTA discussions during the symposium included the hand, larynx, bone, muscle, nerve, tendon, vein, and skin. Over 130 attended the two-day symposium sponsored by Jewish Hospital, University of Louisville, and Kleinert, Kutz and Associates Hand Care Center, PLLC - the partnership who performed the nation's first successful hand transplant.

Highlights of the symposium included presentations by the three surgeons responsible for five of the six hand transplants performed around the world: Warren C. Breidenbach, III, MD, of Kleinert, Kutz and Associates Hand Care Center, PLLC, who performed the United State's first hand transplant; Professor Jean-Michel Dubernard, Hopital Edouard Herriot, Lyon, France, who performed the world's first single and double hand transplants; and Guoxian Pei, MD, PhD, The First Military Medical University, Guangzhou, People's Republic of China, who performed China's first hand transplants.

Dubernard said, "Tolerance or accepting a graft in transplantation is the 'Holy Grail' and we have touched the 'Holy Grail' in transplantation."

Ethical considerations in allotransplantation were also presented by Mark Siegler, MD, MacLean Center for Clinical Medical Ethics, University of Chicago. "My interests are when is it ethically appropriate for surgeons working with interested patients to offer a new technical procedure that has never been performed in a human being and whether the risk/benefit ratio is adequate to allow patients to participate in this type of procedure."

Siegler said, "The risk is the life-long need of immunosuppression, benefit is important in the quality of life in a hand transplant with function, and in the case of Dr. Marshall Strome's patient, the ability to speak again. Both met the ethical test of being appropriate."

Other integral parts of the symposium explored clinical research in immunology therapies, rejection, chimerism, tolerance, new drugs, and various research animal models.

"This is really an historical time in composite tissue allotransplantation, which at the moment is hand transplantation, but may include lower limb transplantation in the future, as well. We have moved very quickly from legend and miracle times to reality and now we have true evidence of successful transplantation," said Mark Hardy, MD, Columbia University, calling for caution and optimism for the future of CTA.

"Success in 100% of the cases [presented at the symposium] is an unusually good beginning for any field of transplantation performed today. This was not true for kidneys, hearts, or lungs in the past, but has been proven for the hand. This is an advantage for the hand surgeons to stand on the shoulders of those who have come before them," he said.

Other CTA presentations/discussions included Marshall Strome, MD, Cleveland Clinic, who performed the world's first larynx transplant; Gunther O. Hofmann, MD, PhD, Munich, Germany, who performed several knee/femur transplants; and J.C. Guimbertau, MD, France, who performed tendon allotransplantation.

The symposium also included presentations by the world's first larynx transplant recipient, and the nation's first hand transplant recipient, as they gave their perspective on the innovative experimental procedures they have undergone.

Breidenbach said, "One of the most informative portions of the symposium was listening to [these patients] in their own terms on what this meant to them."

The symposium included 24 physicians and researchers of international reputation representing Canada, China, France, Germany, and United States. Eight of the original presenters from the first international symposium in November 1997 returned to discuss what they have learned from the experimental procedures performed over the past two years. The 1997 symposium was part of a new "transparent process" protocol followed by the Louisville team before performing the nation's first hand transplant that called for researchers and surgeons to research it and talk about it, before performing the experimental procedure as opposed to the old way of researching it, doing it, and then talking about it.

"The Louisville team will continue to progress cautiously and transparently before proceeding with another hand transplant," said Breidenbach. Currently the team does not have a patient listed to receive a hand transplant, but continues to evaluate candidates.

"It was an exciting two days and extremely helpful," said Breidenbach. "It was an opportunity for the groups from United States, France, and China to exchange data, question the ethics of CTA, and plan how to exchange information in the future."

The groups plan to set up an international registry on CTA for the future exchange of research information like that already in place for other organ transplant information.

This article was prepared by Blood Weekly editors from staff and other reports.