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Pediatric Upper Extremity Vascularized Composite Allotransplantation—Progress and Future

  • Vascularized Composite Allografts (V Gorantla, Section Editor)
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Abstract

Purpose of Review

Since 1998, over 120 upper extremity transplants have been successfully performed around the world; however, the field of vascularized composite allotransplantation (VCA) continues to face various medical challenges and ethical controversies. This article summarizes the worldwide experience with transplantation of vascularized composite upper extremities in children and discusses the unique considerations facing potential pediatric VCA recipients.

Recent Findings

Three children have successfully received composite upper or lower extremity transplants, of which two involved isografts and one involved allografts. Numerous research and clinical advances relevant to VCA have been made, including patient screening, perioperative rehabilitation, allograft preservation and transportation, enhancement of nerve regeneration, understanding of cortical plasticity, and immunomodulatory strategies. Ethical and psychosocial issues remain at the forefront when evaluating potential pediatric VCA recipients.

Summary

For ethically and rigorously screened pediatric patients with debilitating upper extremity absence, VCA is a compelling option to restore form and function and has a promising future.

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Authors and Affiliations

  1. Division of Plastic & Reconstructive Surgery, Hospital for Sick Children, Toronto, Canada

    Kevin J. Zuo, Emily S. Ho, Gregory H. Borschel & Ronald M. Zuker

  2. Division of Plastic & Reconstructive Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada

    Kevin J. Zuo, Gregory H. Borschel & Ronald M. Zuker

  3. Department of Psychology, Hospital for Sick Children, Toronto, Canada

    Anna Gold

  4. Transplant and Regenerative Medicine Centre, Hospital for Sick Children, Toronto, Canada

    Anna Gold

  5. Department of Bioethics, Hospital for Sick Children, Toronto, Canada

    Randi Zlotnik Shaul

  6. Department of Pediatrics, University of Toronto, Toronto, Canada

    Randi Zlotnik Shaul

  7. Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada

    Emily S. Ho

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Zuo, K.J., Gold, A., Zlotnik Shaul, R. et al. Pediatric Upper Extremity Vascularized Composite Allotransplantation—Progress and Future. Curr Transpl Rep 7, 260–269 (2020). https://doi.org/10.1007/s40472-020-00297-9

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