(A and B) An orthotopic hind limb transplantation model based on the nonsuture cuff technique was used to allow for clinical allograft survival monitoring. (A) Representative image of microvascular anastomosis using polyethylene cuff tubes. (B) Long-term survivor on POD 120. (C) Schematic representation of the transplant strategy implemented and the different treatment strategies investigated. These included combination of total body irradiation, CTLA4-Ig, and anti-CD154 mAb (MR1). mixed chimerism analyses combined with other in vitro assays were performed as outlined. (D) Hind limb allograft survival was prolonged with CTLA4-Ig and MR1 without total body irradiation treatment (MST 82 days, n = 8; MST >210 days, n = 6; P = 0.0008), while untreated and CTLA4-Ig only–treated recipients showed acute rejection at MST of 8 days (n = 5) and 15 days (n = 4). P values were calculated by log-rank test (D).