Is Lower Extremity Transplantation a Superior Alternative to Prostheses? No—At Least Not Yet
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Purpose of Review
This paper reviews previously attempted cases of lower extremity vascularized composite allotransplantation (VCA), critically assesses the challenges associated with this procedure, and highlights alternative approaches to restore function for patients with lower limb loss.
Despite progress in the field of upper extremity transplantation, attempts at lower extremity transplantation have resulted in zero successes. Major hurdles that must be overcome prior to future attempts include, but are not limited to, large motor nerve regeneration and immunosuppression-related complications. For those patients unable to achieve satisfactory function with traditional prostheses, alternative strategies involving osseointegration, active prostheses, and advanced human-machine interfaces provide improved function with a more favorable risk/benefit profile.
Given the uncertain functional outcomes and considerable surgical and immunosuppression related risks, lower extremity VCA is far from being a superior alternative to advanced or even traditional prostheses. We believe the transplant community should focus on upper extremity transplantation and revisit this topic as further advances in the field are made.
KeywordsLower extremity amputation Lower extremity vascularized composite allotransplantation Osseointegration Human-machine interface
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
The authors (PDG, SMT, BKP, EAE) are military service members. This work was prepared as part of their official duties. Title 17, USC, §105 provides that “copyright protection under this title is not available for any work of the US Government.” Title 17, USC, §101 defines a US Government work as a work prepared by military service member or employee of the US Government as part of that person’s official duties. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the Department of Defense, Department of the Navy, the Uniformed Services University of the Health Sciences or any other agency of the US Government.
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