Vascularised Composite Allotransplantation – Basic Science and Clinical Applications

Vascularised Composite Allotransplantation (VCA) is the top rung of the reconstructive ladder, offering ‘like-for like’ functional reconstruction for the most devastating tissue loss. There are established centres across Europe, the USA and Asia. Clinical outcomes now extend beyond 20 years. To-date over 130 upper limb and 37 craniofacial VCA’s have been performed, with encouraging graft survival and clinical outcomes. Beyond hand and face transplantation novel VCA’s have been performed including: functioning allotransplantation of neck organs, penis, uterus and skull and scalp transplants. Like solid organ transplant (SOT) patients, VCA recipients are submitted to the significant side effects of lifelong immunosuppression, however in this case surgery is considered life improving rather than life saving. As clinical feasibility is now well established research focus has shifted to improve the safety profile of VCA. This has included exploring strategies to enable early detection and treatment of acute rejection, defining and better understanding chronic rejection in VCA, and ultimately aiming to induce tolerance. The aim of this review article is to give a concise overview of the clinical and basic science advances in the field of VCA, with particular relevance to the orthoplastic surgeon.