Duke Transplant Services will establish a program dedicated to composite-tissue allotransplantation (CTA), a promising new transplant specialty.

A multidisciplinary interface of plastic/reconstructive surgery and transplant surgery, CTA involves grafting skin, muscle, bone, and other bodily structures. There are currently only five U.S. centers performing CTA procedures.

CTA aims to restore appearance and function in patients with extensive tissue loss -- such as facial disfigurement and limb loss -- by replacing that tissue with similar structures from deceased donors. The pre- and post-transplant care of CTA patients mirrors that of solid-organ transplant recipients, including immunosuppression.

The success of more than 50 hand, 15 abdominal wall, and 11 face transplants worldwide has generated hope for this evolving field, as many people suffer from serious musculoskeletal deficits that conventional plastic surgical techniques cannot correct.

The major advantage of CTA grafts is that they are readily visible and easily accessible for biopsy to monitor immunological events such as acute and chronic rejection. This aspect has the potential to individualize immunosuppression therapies and avoid related complications.

Duke surgeons who will be involved in the CTA program include those with prior CTA experience, including hand transplantation. These faculty members are currently conducting basic research and reviewing potential clinical cases. The first patients to be considered for CTA will be those with large abdominal wall defects that cannot be reconstructed with traditional surgery.

To learn more about CTA at Duke, please contact Kadiyala Ravindra, MD, at 919-613-6133 or Detlev Erdmann, MD, PhD, MHSc, at 919-684-3320.