Solid organ transplantation has evolved from a highly experimental and risky procedure to the standard of care and the treatment of choice of end-stage organ failure in the past four decades. For practical purposes, the first successful kidney transplant by Murray in the 1950s, followed by a successful heart transplant by Barnard heralded a new age of promise for patients with end-stage organ disease. The goals underlying all solid organ transplantation are unified: replacement of a dysfunctional host organ with a transplanted allograft that restores the function of the compromised organ. However, there are many subtle and profound differences between various aspects of organ transplantation specific to the type of allograft being transplanted, including the patient population, alternative therapies, donor population, immunogenicity of allografts, immunosuppressive regimens, risk of rejection, and the consequences of rejection/allograft loss. These considerations are relevant to transplant dermatology in important ways including the susceptibility of the patient population to specific skin diseases, particularly skin cancer, the relative carcinopermissiveness of the immunosuppressive regimen, the degree to which reduction or alteration of immunosuppression is possible, and the consequences if reduction of immunosuppression results in allograft rejection/loss. This chapter will consider these issues for each major allograft type, which are summarized in Table 6.1.

Because the relative immunogenicity of various allografts is integral to the considerations of this chapter, we present a rough approximation of immunogenicity.