The restoration of nerve integrity and return of meaningful nerve function following injury to both peripheral and cranial nerves remains a significant clinical problem. The use of nerve allografts with temporary host immunosuppression is an attractive potential alternative to conventional autografts to bridge nerve gaps. Allotransplantation would supersede the issues of there being a finite quantity of expendable nerves for autograft use, as well as the comorbidities from their harvest, such as scar, numbness or neuroma formation. The development of clinically applicable strategies for host immunosuppression will permit immediate reconstruction via transplantation of allogenic nerve material. Donor- specific immunosuppression with monoclonal antibodies (mAbs) against cellular adhesion molecules has recently been approached as a method of preventing graft rejection without impairing systemic immune function. The binding of cell surface molecules ICAM-1 and LFA-1 is a critical step in the initiation of T-cell mediated rejection. Short term administration of mAbs to ICAM-1 and LFA-1 has been shown to alter adhesion of lymphocytes to allografts, resulting in decreased rejection and prolonged graft survival. Additionally, these mAbs appear to alter lymphocyte recognition and induce donor-specific immunotolerance.
