Malignancies after vascularized composite allotransplantation

Area of Science:

• Transplantation immunology
• Oncology
• Regenerative medicine

Background:

• Vascularized composite allotransplantation (VCA) offers reconstructive solutions for complex defects.
• Long-term oncologic safety data following VCA remains limited.

Purpose of the Study:

• To comprehensively review and analyze malignancies that occur after VCA.
• To characterize the incidence, types, and outcomes of post-VCA malignancies.

Main Methods:

• Systematic review following PRISMA guidelines, searching PubMed, EMBASE, and Web of Science.
• Inclusion of case reports and registry data (OPTN).
• Risk of bias assessment using JBI Critical Appraisal Checklist.

Main Results:

• Analysis of 22 malignancies in 15 patients; 41% were non-melanoma skin cancer (NMSC), 36% were lymphoproliferative disorders.
• Median time to malignancy was 24 months post-VCA.
• Malignancy-associated mortality was 33%; 23% of malignancies required immunosuppression modification.

Conclusions:

• Post-VCA malignancies present a significant mortality risk, dominated by NMSC and lymphoproliferative disorders.
• Patient-reported symptoms preceded diagnosis in some cases, highlighting the need for education.
• Recommendations include careful patient selection, dermatologic screening, and EBV surveillance for early detection.