Outcomes And Experience In VCA - "A Global Perspective"
Lawrence S. Levin, MD1, Palmina Petruzzo, MD2.
1University of Pennsylvania, Philadelphia, PA, USA, 2Università degli studi di Cagliari, Cagliari, Sardinia, Italy.
The International Hand and Composite Tissue Transplantation Registry is the largest and most complete data bank in the world for VCA. Beginning with hand transplant, face, abdominal wall, larynx and uterus have been transplanted with success. To date 48 complete or partial face transplants have been reported, with two re-transplants performed. Only one face and simultaneous bilateral hand transplant has been successful. Compared to other VCA's death rate is higher (six deaths reported to the registry following transplant) and patient satisfaction is very high. 78 cases of upper extremity transplant have been reported to the Registry. 31 cases are unilateral, 47 cases bilateral (hand and distal wrist) and 8 cases are at the proximal forearm or above elbow. Six recipients, 4 unilateral and 2 bilateral UET, were amputated in a period ranging from 265 to 4680 days due to chronic rejection or poor function. Two deaths occurred-one on POD 1. At present a least 70 uterus transplants have performed, and 20 healthy infants delivered. Teams from Europe, North America, South America, and Asia have reported live births. Transplants are from living or deceased donors. Two cases of pediatric VCA have been reported. A total laryngeal transplant in child and bilateral transplant in a child and regained excellent function. Challenges remain regarding ideal immunosuppression, chronic rejection, standardization of outcomes and funding. All VCAs are not lifesaving procedures and the balance risks/benefits must be carefully evaluated. VCA represents the highest rung on the microsurgical reconstructive ladder. Restorative surgery continues to evolve.
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