Pediatric Upper Extremity Replantation: Courage in the Face of a Life-altering Injury

Purpose of review We review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from our bilateral pediatric hand–forearm transplantation. Recent findings In 2015, the first heterologous pediatric upper extremity hand–forearm transplant was performed at the Children's Hospital of Philadelphia, and in 2019, the first pediatric neck reconstructive transplantation was performed in Poland. The 5-year follow-up of the pediatric upper extremity recipient demonstrates similar growth rates bilaterally, an increase in bone age parallel to chronologic age, and perhaps similar overall growth to nontransplant norms. The pediatric upper extremity recipient continues to make gains in functional independence. He excels academically and participates in various extracurricular activities. Future challenges unique to the pediatric population include ethical issues of informed consent, psychosocial implications, limited donor pool, posttransplant compliance issues, and greater life expectancy and therefore time to inherit the many complications of immunosuppression. Summary Currently, we recommend pediatric vascularized composite allotransplantation (VCA) for bilateral upper extremity amputees, preferably on immunosuppression already, and those patients who would have the most potential gain not available through standard reconstructive techniques while being able to comply with postoperative immunosuppression protocols, surveillance, rehabilitation, and follow-up.

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The current outcomes and future challenges in pediatric vascularized composite allotransplantation

Azoury

Lin

Amaral

et al. 2020

Current Opinion in Organ Transplantation

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Four-Year Follow-Up of the World’s First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?

Azoury

Milbar

Kimia

et al. 2020

Plastic &Amp; Reconstructive Surgery

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Background: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time. Methods: Forearm and hand radiographs were obtained annually. Radius and ulna measurements were performed by multiple coauthors and mathematically normalized using a standardized methodology. The Greulich and Pyle atlas was used to estimate hand bone age. Results: From July of 2015 to July of 2019, unadjusted bone length (metaphysis to metaphysis) increased 38.8 and 39.6 mm for the left radius and ulna, and 39.5 and 35.8 mm for the right radius and ulna, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes. Normalized growth between the two limbs was statistically similar. At each annual follow-up, the bone age increased by 1 year. Conclusions: Successful pediatric hand-forearm transplantation offers the advantage of growth similar to that of nontransplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. Chronologic age parallels the increase in bone age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

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Pediatric Upper Extremity Replantation: Courage in the Face of a Life-altering Injury

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Cited by 2 publications

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The current outcomes and future challenges in pediatric vascularized composite allotransplantation

The current outcomes and future challenges in pediatric vascularized composite allotransplantation

Four-Year Follow-Up of the World’s First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?

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