Review ArticleImpact of Donor Bone Marrow on Survival of Composite Tissue AllograftsSiemionow, Maria MD, PhD, DSc; Nasir, Serdar MDAuthor Information From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH. Reprints: Maria Siemionow, MD, PhD, DSc, Department of Plastic Surgery Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A-60, Cleveland, OH 44195. E-mail: [email protected]. Annals of Plastic Surgery: April 2008 - Volume 60 - Issue 4 - p 455-462 doi: 10.1097/SAP.0b013e3180db2765 Buy Metrics Abstract Composite tissue allotransplants (CTA) involves transplantation of various tissues including vessels, nerves, skin, and immune cells and bears significant antigenic load. Different immunosuppressive protocols are used for experimental and clinical CTA. Immunosuppressive agents maintain survival of the different components of composite tissue allografts. However, the potential side effects of chronic immunosuppression currently limit the widespread application of CTA transplants. Bone marrow therapy in many tolerance induction protocols therefore provides a guide to reaching the target of permanent immunotolerance. Multiple studies suggest that bone marrow is immunomodulatory and may facilitate allograft acceptance. In this review, bone marrow–based therapy protocols of experimental and clinical models are presented in composite tissue transplantation. © 2008 Lippincott Williams & Wilkins, Inc.