Analyzing the candidate pool for Vascularized Composite Allotransplantation - A multi-center OPTN study with a focus on face transplant candidates.

Vascularized Composite Allotransplantation (VCA) provides reconstructive options for patients with severe tissue trauma, yet multi-center analyses of VCA candidates remain scarce. This study analyzed the Organ Procurement and Transplantation Network (OPTN) database to assess the VCA candidate pool and comparatively analyzed facial VCA (fVCA) and non-fVCA to better understand their specific characteristics. The OPTN database was searched from 2008 to 2024, including all VCA types and excluding patients under 18 years or with extreme body mass indices (BMI; <7 kg/m² or >250 kg/m²). Demographic, immunological and listing-related variables were examined, exploratorily comparing fVCA candidates to other VCA candidates. Overall, 46 candidates were listed with an average age of 38 ± 12 years. fVCA candidates were significantly older (54 ± 4 years vs. 45 ± 11 years; p < 0.0001) with a higher BMI (30 ± 3 kg/m² vs. 25 ± 8 kg/m²; p = 0.02). Average listing time was 949 ± 686 days, with 13 % dying during listing. fVCA candidates had longer waiting times (1129 ± 772 days). This analysis highlights the limited VCA candidate pool, with fVCA candidates, albeit limited in sample size, being older, having higher BMIs and longer average listing times. Overall, these insights call for cross-disciplinary efforts to make VCA more accessible and optimize patient recruitment and selection.