Is Vascularized Composite Allograft Transplantation Experimental or an Accepted Surgical Procedure: Results from a National Survey

Abstract

Background More than 85 patients have received over 100 hand/arm transplants and more than 35 patients have received full or partial face transplants at institutions around the world. Given over two decades of experience in the field and in the light of successful outcomes with up to 17 years follow up time, should we still consider vascularized composite allograft (VCA) as a research/clinical investigation? We present the results of a nationwide electronic survey whose intent was to gather institutional bias with regard to this question.

Methods An 11 question survey that was developed by VCA advisory committee of American Society of Transplantation was sent to all identified Internal Review Board chairs or directors in the United States.

Results We received a total of 54 responses (25.3%) to the survey. The majority (78%) of responses came from either the chairperson, director, or someone who is administratively responsible for an IRB.

Conclusion Though certainly not an exhaustive investigation into each institution's preference, we present a representative sampling. The results of which favor VCA as an accepted clinical procedure given the appropriate setting. Further research is needed to fully ascertain practices at each individual institution.

Keywords

vascularized composite allograft - hand transplantation - face transplantation

• References

• 1 Merrill JP, Murray JE, Harrison JH, Guild WR. Successful homotransplantation of the human kidney between identical twins. J Am Med Assoc 1956; 160 (04) 277-282
• 2 Grajek M, Maciejewski A, Giebel S. , et al. First complex allotransplantation of neck organs: larynx, trachea, pharynx, esophagus, thyroid, parathyroid glands, and anterior cervical wall: a case report. Ann Surg 2017; 266 (02) e19-e24
• 3 Breidenbach WC, Gonzales NR, Kaufman CL, Klapheke M, Tobin GR, Gorantla VS. Outcomes of the first 2 American hand transplants at 8 and 6 years posttransplant. J Hand Surg Am 2008; 33 (07) 1039-1047
• 4 Hofmann GO, Kirschner MH, Brauns L, Wagner FD, Land W, Bühren V. Vascularized knee joint transplantation in man: a report on the first cases. Transpl Int 1998; 11 (Suppl. 01) S487-S490
• 5 Dubernard JM, Owen E, Herzberg G. , et al. Human hand allograft: report on first 6 months. Lancet 1999; 353 (9161): 1315-1320
• 6 Strome M, Stein J, Esclamado R. , et al. Laryngeal transplantation and 40-month follow-up. N Engl J Med 2001; 344 (22) 1676-1679
• 7 Dubernard JM, Petruzzo P, Lanzetta M. , et al. Functional results of the first human double-hand transplantation. Ann Surg 2003; 238 (01) 128-136
• 8 Levi DM, Tzakis AG, Kato T. , et al. Transplantation of the abdominal wall. Lancet 2003; 361 (9376): 2173-2176
• 9 Hu W, Lu J, Zhang L. , et al. A preliminary report of penile transplantation. Eur Urol 2006; 50 (04) 851-853
• 10 Devauchelle B, Badet L, Lengelé B. , et al. First human face allograft: early report. Lancet 2006; 368 (9531): 203-209
• 11 Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynaecol Obstet 2002; 76 (03) 245-251
• 12 Birchall M. Tongue transplantation. Lancet 2004; 363 (9422): 1663
• 13 Brännström M, Johannesson L, Bokström H. , et al. Livebirth after uterus transplantation. Lancet 2015; 385 (9968): 607-616
• 14 Siemionow M. The miracle of face transplantation after 10 years. Br Med Bull 2016; 120 (01) 5-14
• 15 Federal Register, Volume 78, Issue 128/Wednesday, July 3, 2013/Proposed Rules. Department of Health and Human Services 42 CFR Part 121. Available at: https://www.govinfo.gov/content/pkg/FR-2013-07-03/pdf/2013-15950.pdf . Accessed January 10, 2020