Facial and Hand Allotransplantation

Abstract

Vascularized composite allotransplantation (VCA) is a novel therapeutic option for treatment of patients suffering from limb loss or severe facial disfigurement. To date, 72 hand and 19 facial transplantations have been performed worldwide. VCA in hand and facial transplantation is a complex procedure requiring a multidisciplinary team approach and extensive surgical planning. Despite good functional outcome, courses after hand and facial transplantation have been complicated by skin rejection. Long-term immunosuppression remains a necessity in VCA for allograft survival. To widen the scope of these quality-of-life-improving procedures, minimization of immunosuppression to limit risks and side effects is needed.

Engineered composite tissue as a bioartificial limb graft

“…Moreover, regeneration of sensory nerves, resulting in restoration of discriminative sensation, can be observed in the same patients (7). Notably, decellularized nerve grafts are already in clinical use to bridge nerve gaps in sensory, motor and mixed nerves (26).…”

“…Restoration of intrinsic hand muscle function in hand transplant recipients shows that regeneration of neuromuscular junctions in a whole limb is possible (7). Moreover, regeneration of sensory nerves, resulting in restoration of discriminative sensation, can be observed in the same patients (7).…”

“…The vast majority of patients consider the option of prosthesis, but amputees who suffer from large defects such as bilateral above elbow amputations adapt poorly and are usually dependent on others for personal care and hygiene (6). As a new approach, worldwide about 70 patients have received allogeneic hand transplants since 1998(7). Hand transplantation significantly improved the quality of life of upper limb amputees and eventually demonstrated hand function superior to that obtained with prosthetics (6, 8, 9).…”

Long-term Tolerance Toward Haploidentical Vascularized Composite Allograft Transplantation in a Canine Model Using Bone Marrow or Mobilized Stem Cells

“…6–9 Increasing the amount of chronic immunosuppression in an attempt to prevent rejection leads to drug toxicity and ultimately can result in opportunistic infections, diabetes, nephrotoxicity, and even malignancy in the recipients. 10,11 Efforts to limit the use of immunosuppression or to transplant donor marrow without preconditioning to prevent these complications has led to acute rejection and even loss of the allograft. 12–15 …”

Local administration of Mitomycin‐C‐Treated peripheral blood mononuclear cells (PBMCs) prolongs allograft survival in vascularized composite allotransplantation

“…Vascularized composite allotransplantation (VCA) is a rapidly evolving field with considerable prospects in reconstructive surgery by restoring structure, function, and aesthetics. Over the last decade the most widely recognized types of VCA, hand, and face transplantations, have shown remarkable clinical results . In contrast to solid organ transplants, graft acceptance and tolerance in VCA is more difficult to accomplish.…”