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Hand transplantation is currently the most controversially discussed issue in the field of clinical transplantation. After the first hand of the "new era" was transplanted in Lyon in 1998, the debate on whether hand transplantation is justified or not resulted in numerous debates in the scientific press and the public media. Subjective conclusions and recommendations rather than a scientific evaluation of the current results have resulted in polarization between those pro and those contra hand transplantation. Initial fears that the transplanted limbs might be irreversibly rejected early after transplantation and that function would be poor were disproved. Instead, 100% graft survival at 1 year after hand transplantation is superior to the outcome achieved in any type of solid organ transplantation. However, the side effects related to the immunosuppressive treatment, the uncertain long-term outcome, the limited number of recipients meeting the required criteria together with the high cost of surgery, rehabilitation, and immunosuppression may be responsible for the decreased activity seen in this field in recent years. [ABSTRACT FROM AUTHOR]

A composite tissue comprises tissues derived from all three germ layers: ectoderm, mesoderm, and endoderm. Following transplantation, each component induces an immune response, which differs in character and intensity. Skin has been shown to be the most antigenic tissue and is the first tissue to be rejected in animal models and human transplants. The heightened antigenicity of skin has been attributed to Langerhans' dendritic cells and skin-specific antigens. Muscle, bone, cartilage, and nerve predictably induce a relatively lower immune response in that order. However, rejection of even one component of a composite tissue renders the entire allograft vulnerable to dysfunction. The knowledge of relative antigenicity can lead to the development of strategies intended to decrease the antigenicity of a specific component. In addition, a better understanding of this relative antigenicity of allograft components enables the concept of tailored immunosuppression targeting only specific cellular and humoral components of rejection. This would limit the amount of immunosuppression used and the consequent related complications of opportunistic infections and malignancies. [ABSTRACT FROM AUTHOR]