Autotransplantation

Autotransplantation (from the Ancient Greek αὐτός — “self” and Latin transplantare — “to transplant”) is a type of transplantation in which the same individual serves as both donor and recipient. During this procedure, tissue or an organ is harvested and relocated from one site to another within the body of one and the same person.

The transplanted material is referred to as an autograft or autotransplant. The primary, fundamental advantage of this technique is the complete absence of immunologic rejection, as the immune system recognizes the transplanted tissue as the body’s own.

Key Principles and Advantages

The core principle of autotransplantation is the use of the body’s own regenerative and reconstructive resources to repair defects or restore function.

Primary advantages include:

• Immunological compatibility: Complete absence of graft rejection, a major concern in transplants from other donors.
• No need for immunosuppression: The patient does not require lifelong immunosuppressive therapy, thereby avoiding serious side effects such as increased infection risk, renal toxicity, and malignancy.
• High graft survival rates: Autografts typically integrate well with surrounding tissues and demonstrate excellent viability.
• No risk of donor-transmitted infections (e.g., HIV, hepatitis viruses).

The main drawback of autotransplantation is that an additional surgical site (donor wound) is created; moreover, the quantity and volume of tissue available for transfer is limited.

Clinical Applications

Autotransplantation is considered the gold standard in many fields of reconstructive surgery.

• Plastic Surgery and Burn Medicine:
  • Skin grafting: Harvesting split-thickness skin grafts from healthy areas (e.g., the thigh) to cover extensive burn or wound surfaces.
• Traumatology and Orthopedics:
  • Bone grafting: Using autologous bone fragments, often from the iliac crest, to fill bone defects or promote healing in complex fractures.
  • Ligament reconstruction: Repairing the anterior cruciate ligament of the knee using autologous tendon grafts.
• Cardiovascular Surgery:
  • Coronary artery bypass grafting (CABG): Creating an alternative route for blood flow to the heart using the patient’s own great saphenous vein (vena saphena magna)or internal thoracic artery.
• Hematology and Oncology:
  • Autologous hematopoietic stem cell transplantation: Involving collection, cryopreservation, and reinfusion of the patient’s own stem cells following high-dose chemotherapy.
• Otolaryngology:
  • Tympanoplasty: Repairing tympanic membrane perforations using fascia from the temporalis muscle or auricular cartilage.
  • Septorhinoplasty: Using autografts to shape and support nasal structures — for example, straightening the nasal dorsum, refining the tip, or preventing tip ptosis. Septal cartilage is most commonly used due to its pliability and proximity to the surgical field.

Comparison with Other Types of Transplantation

Autotransplantation should be distinguished from allotransplantation that is performed between individuals of the same species (e.g., kidney, liver, or heart from another human). This approach carries a risk of rejection and necessitates ermanent immunosuppressive therapy. Xenotransplantation involves organs and tissues from a different species (e.g., animal to human). Isotransplantation is a procedure involving genetically identical individuals (e.g., monozygotic twins), which — like autotransplantation — does not elicit a rejection response.