New Perspectives in Tolerance Induction for Vascularized Composite Allotransplantation

Although transplantation of Vascularized Composite Allografts (VCA) has become a clinical reality, complications resulting from long-term immunosuppression remain major barriers to broader indication. Ideally, induction of tolerance has been considered the Holy Grail in both solid organ and VCA transplantation. Recent advances in immunomodulatory medication and cell-based therapy exploiting donor bone marrow (BM) cells, regulatory T cells (Tregs) and mesenchymal stem cells have opened exciting opportunities for tolerance induction in VCA transplantation. This mini-review focuses on current understanding of these drugs and cell-based immunomodulatory strategies and their role(s) in tolerance induction for VCA transplantation.