OPTN/SRTR 2024 Annual Data Report: Vascularized Composite Allograft

This chapter provides a comprehensive summary of data collected over roughly the past decade, beginning in 2014 when vascularized composite allografts (VCAs) were incorporated into the Final Rule and brought under the definition of solid organ transplantation. As in previous years, the number of VCA procedures in the United States remains low, with 55 uterus transplants and 37 nonuterus transplants reported from 2014 through 2024. While the limited volume precludes definitive conclusions, several consistent trends are observed. Among nonuterus VCA transplants, upper limb remained the most common overall, although head and neck transplants were most frequent in 2024. Nonuterus transplants in 2014-2024 were most often performed in recipients aged 18-34 years, with donors typically drawn from the same age range. Trauma remained the leading indication for nonuterus VCA transplant. White and male recipients were the most common recipients of nonuterus VCA transplant. Uterus transplants were most frequently performed in White women aged 18-34 years, typically for congenital indications. From 2016 through 2024, there were 10 reported uterus graft failures, and only one reported failure of a nonuterus graft-in the upper limb category-since 2014. Although the number of transplants and reported graft failures remained relatively low, the field continues to advance through ongoing efforts to develop standardized outcome measures, standardized definitions of graft success and failure, and standard operating procedures in hand and face transplantation. These initiatives are beneficial for improving data comparability, guiding clinical decision-making, and supporting sustained progress in VCA research and patient care.