Vascularized composite allotransplantation in the United States: A retrospective analysis of the Organ Procurement and Transplantation Network data after 5 years of the Final Rule

Abstract

| 291 amjtransplant.com 1 | INTRODUC TI ON 1.1 | Background Vascularized composite allotransplantation (VCA) refers to the transplantation of components such as nerve, tendon, skin, and/ or bone as a functional unit to reconstruct tissues that cannot be reconstructed with autologous tissue. VCA is an evolving field of transplantation that is built upon foundational science in vascular biology, microsurgery, and immunology. The first successful solid organ transplantation (SOT) by Joseph Murray in 1954 depended upon precepts developed decades earlier by immunologists like Karl Landsteiner and Peter Medawar. 1 Landsteiner, best remembered for his discovery of ABO blood groups, spent parts of his early career transplanting lymph nodes between guinea pigs, 2 and Medawar began his immunology research by transplanting soft tissues in wounded British soldiers. 3 Coupled with improved immunomodulatory drugs and refinement of vascular and microsurgical techniques, 4,5 VCAs have become technically feasible, with the first successful hand transplantation in 1998. 6 Today, an increasing number of organs have been transplanted, including upper extremities, face, abdominal wall, and uterus.

TRFs and tiRNAs sequence in acute rejection for vascularized composite allotransplantation

“…To prevent rejection after the operation, recipients usually receive routine immunosuppressive therapy. However, some patients will experience acute rejection attacks even with immunosuppressive therapy 3 . VCA, like organ transplantation, faces problems such as long-term survival and dysfunction.…”

OPTN/SRTR 2020 Annual Data Report: VCA

“…For upper limb transplant, 3 functional metrics are included in the OPTN database; quantitative evaluation of upper extremity function; Disability of Arm, Shoulder and Hand (DASH) score; and Semmes‐Weinstein test, which evaluates sensory recovery 7‐9 . Of the data reported to the OPTN 5 years after July 3, 2014, patients showed improvement in the quantitative function scores, the DASH scores, and the sensory recovery test after hand transplant; among face transplant recipients, 50% had their tracheostomy decannulated and regained their sense of smell, 33% had their feeding tube removed, and the same percentage regained the ability protect their cornea through eye closure 10 …”

Sensitization and Desensitization in Vascularized Composite Allotransplantation

“…Trauma patients waiting for hand or face VCA, without extensive transfusion requirement or prior skin transplant, are mostly healthy, young individuals with a low risk of pre-existing sensitization. According to the literature, more than 80% of the patients who have received reconstructive VCAs (hand or face) are male with an average age of about 30 years ( 15 , 16 ). On the contrary, the average age for kidney transplantation is above 45 years with more than 60% being males ( 17 ).…”