1. Long-term Outcomes After Facial Allotransplantation: Systematic Review of the Literature
- Author
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Bianief Tchiloemba, Ali-Farid Safi, Branislav Kollar, Obada Abdulrazzak, Martin Kauke, Bohdan Pomahac, and Valentin Haug
- Subjects
Adult ,Graft Rejection ,Male ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,lcsh:Surgery ,MEDLINE ,Infections ,Vascularized Composite Allotransplantation ,Quality of life ,Poster Abstracts ,medicine ,Long term outcomes ,Humans ,Transplantation, Homologous ,Lung cancer ,Transplantation ,business.industry ,Immunosuppression ,lcsh:RD1-811 ,Middle Aged ,medicine.disease ,Metabolic complication ,Research Design ,Quality of Life ,Female ,Surgery ,business ,Immunosuppressive Agents ,Facial Transplantation ,Allotransplantation - Abstract
Background Facial vascularized composite allotransplantation (fVCA) represents a reconstructive approach that enables superior improvements in functional and esthetic restoration compared to conventional craniomaxillofacial reconstruction. Outcome reports of fVCA are usually limited to short-term follow-up or single-center experiences. We merge scientific literature on reported long-term outcome data to better define the risks and benefits of fVCA. Methods We conducted a systematic review of PubMed/MEDLINE databases in accordance with PRISMA guidelines. English full-text articles providing data on at least 1 unique fVCA patient, with ≥ 3 years follow-up, were included. Results The search yielded 1812 articles, of which 28 were ultimately included. We retrieved data on 23 fVCA patients with mean follow-up of 5.3 years. More than half of the patients showed improved quality of life, eating, speech, and motor and sensory function following fVCA. On average, the patients had 1 acute cell-mediated rejection and infectious episode per year. The incidence rates of acute rejection and infectious complications were high within first year posttransplant but declined thereafter. Sixty-five percent of the patients developed at least 1 neoplastic and/or metabolic complication after transplantation. Chronic vascular rejection was confirmed in 2 patients, leading to allograft loss after 8 and 9 years. Two patient deaths occurred 3.5 and 10.5 years after transplant due to suicide and lung cancer, respectively. Conclusions Allograft functionality and improvements in quality of life suggest a positive risk-benefit ratio for fVCA. Recurrent acute rejection episodes, chronic rejection, immunosuppression related complications, and heterogeneity in outcome reporting present ongoing challenges in this field.
- Published
- 2021