Title

The current outcomes and future challenges in pediatric vascularized composite allotransplantation.

Year of Publication

2020

Number of Pages

576-583

Date Published

2020 Dec

ISSN Number

1531-7013

Abstract

<p><strong>PURPOSE OF REVIEW: </strong>We review the outcomes and future challenges associated with pediatric vascularized composite allotransplantation, including follow-up data from our bilateral pediatric hand-forearm transplantation.</p>

<p><strong>RECENT FINDINGS: </strong>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.</p>

<p><strong>SUMMARY: </strong>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.</p>

DOI

10.1097/MOT.0000000000000809

Alternate Title

Curr Opin Organ Transplant

PMID

33044345

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