Founding the ASRT Military Working Group
Founding the ASRT Military Working Group
On January 27, 2009, a working group of ASRT members and their associates, who share an interest in the safe an efficacious use of CTA to treat wounded warriors, met in Pittsburgh PA.
On January 27, 2009, a working group of ASRT members and their associates, who share an interest in the safe an efficacious use of CTA to treat wounded warriors, met in Pittsburgh PA, at the McGowan Institute for Regenerative Medicine. A consensus statement of the ASRT military working group represents the shared view and its commitment to making CTA a clinically-relevant treatment for our war wounded.
THE ASRT MILITARY WORKING GROUP ON COMPOSITE TISSUE TRANSPLANTATION
POSITION STATEMENT
Background: Conventional reconstruction after major trauma, burns, and extirpative surgery are limited by the availability of appropriate tissues. In addition, complicating factors such as morbidity from extensive surgery, prolonged rehabilitation and costs of multiple procedures further compromise outcomes. For certain complex injuries not amenable to conventional reconstruction, composite tissue allo-transplantation (CTA) can restore optimal functionality and appearance. CTA is now a clinical reality. During the past decade, more than 100 CTA procedures have been performed around the world, including over 40 hand and 4 facial transplants with encouraging outcomes.
Key Military Impact of CTA: CTA allows us for the first time to reconstruct extremities and faces, restoring our injured service members and enabling more of them to return to duty and normal activities of daily living. CTA represents an immediate clinical deliverable for our wounded warriors.
Current Drug Treatment in CTA: We now have experience with CTA demonstrating long-term graft survival with immunosuppression similar to that used in solid organ transplants. Steroid avoidance has been achieved in a series of patients and multiple programs are actively engaging in further drug minimization. These programs are being developed through robust, multi-institutional collaborations with oversight by the Food and Drug Administration and local Institutional Review Boards.
ASRT Recommendations: The ASRT makes the following recommendations for CTA centers:
1) Centers should have a multi-disciplinary team (including reconstructive and transplant surgeons, immunologists, pathologists, infectious disease specialists, psychiatrists, ethicists, therapists, social workers) and appropriate infrastructure;
2) All CTA protocols should be approved by Institutional Review Boards;
3) All recipients must undergo a thorough informed consent that includes the benefits and risks, alternate options, coverage of costs, treatment of complications and exit strategies;
4) Centers must document, report and share study outcomes with regulatory authorities as well as with scientific peers.
Opportunities Ahead: CTA can provide an important addition to the technologies available for treatment of complex traumatic injury. While prostheses are considered helpful and routine to “bridge” between injury and reconstruction, transplantation has the means to achieve near perfect restoration of form and function. We recognize four important characteristics of CTA as they relate to military use:
1) We have the ability to reconstruct previously uncorrectable defects;
2) We have an opportunity to assist in conserving the fighting force;
3) While we are encouraged by early successes, CTA is still in its early stages, and continued progress requires the continuation of research at our institutional, military, and Veteran’s Administration hospitals;
4) This technology is clinically deliverable today;
About the American Society of Reconstructive Transplantation: The ASRT is an international and collaborative effort involving surgeons, transplant immunologists, organ procurement organizations and specialists in rehabilitation, psychology and medical ethics. It is the goal of the ASRT to support the advancement of reconstructive transplantation by promoting high standards in clinical care, science and ethical practice. Contact and further information: www.a-s-r-t.com
About the Military Working Group of the ASRT: On January 27, 2009, a working group of ASRT members and their associates, who share an interest in the safe an efficacious use of CTA to treat wounded warriors, met in Pittsburgh PA, at the McGowan Institute for Regenerative Medicine. The preceding statement represents the shared view this working group and its commitment to making CTA a clinically relevant treatment for our war wounded.
