From Kidney Transplants to Vascularized Composite Allografts: The Role of the Plastic Surgeon in Transplantation

In 1954, plastic surgeon Dr Joseph Murray performed the first successful organ transplant between identical twins. Today solid organ transplants are performed routinely and offer a curative option for patients with end stage organ failure. For his pioneering work in transplantation biology, Dr Murray remains the only plastic surgeon to have been awarded the Nobel Prize in Medicine. The success of modern day transplants has allowed transplantation to be applied more broadly. In particular, vascularized composite allografts (VCAs), including face and hand transplants, have emerged over the past 15 y. These have been used for reconstruction of patients with extensive disfigurements. Despite these great successes, the use of chronic immunosuppression by transplant recipients is accompanied by the risk of malignancy, organ toxicity and infection. Current research efforts by transplant physicians and plastic surgeons are aimed at reducing and subsequently eliminating the burden of life-long immunosuppression. This review will provide a historical overview of the contributions of plastic surgeons in the development of modern day transplantation. Subsequently we will examine the emergence of vascularized composite allografts. Finally, future directions in which plastic surgeons are contributing to transplant biology are mentioned.