Face, upper extremity, and concomitant transplantation: potential concerns and challenges ahead.

Area of Science:

• Reconstructive surgery
• Transplant surgery
• Immunology

Background:

• Composite tissue allotransplantation has evolved from early rat allograft studies.
• It addresses massive facial and upper extremity defects but requires lifelong immunosuppression.
• This poses risks and raises questions about risk-benefit ratios, especially for bilateral vs. unilateral transplants.

Purpose of the Study:

• To review the current status and outcomes of face and upper extremity allotransplantation.
• To highlight critical factors for successful upper extremity transplantation.
• To discuss the implications of concomitant composite tissue allotransplantation.

Main Methods:

• Review of global hand and face transplant data since 1998 and 2005, respectively.
• Analysis of factors influencing upper extremity transplant success.
• Examination of cases involving simultaneous face and other tissue allotransplantation.

Main Results:

• Nearly 50 hand transplants and nine face transplants have been performed globally.
• Patient compliance and intensive rehabilitation are crucial for upper extremity transplant success.
• Face transplantation has a 2-year mortality of 20%, with some cases involving simultaneous hand or other tissue transplants.

Conclusions:

• Composite tissue allotransplantation is a promising reconstructive tool but carries significant risks.
• Further research is needed to determine optimal strategies for combined tissue allotransplantation.
• Patient selection, compliance, and rehabilitation are paramount for successful outcomes.