Long-term outcomes after facial allotransplantation

• Verfasst von: Tchiloemba, Bianief [VerfasserIn]
• Verfasst von: Kauke-Navarro, Martin [VerfasserIn]
• Verfasst von: Haug, Valentin [VerfasserIn]
• Verfasst von: Abdulrazzak, Obada [VerfasserIn]
• Verfasst von: Safi, Ali-Farid [VerfasserIn]
• Verfasst von: Kollár, Branislav [VerfasserIn]
• Verfasst von: Pomahac, Bohdan [VerfasserIn]
• Titel: Long-term outcomes after facial allotransplantation
• Titelzusatz: systematic review of the literature
• Verf.angabe: Bianief Tchiloemba, MSc, Martin Kauke, MD, Valentin Haug, MD, Obada Abdulrazzak, BA, Ali-Farid Safi, MD, Branislav Kollar, MD, and Bohdan Pomahac, MD
• Jahr: 2021
• Umfang: 12 S.
• Fussnoten: Gesehen am 13.10.2021
• Titel Quelle: Enthalten in: Transplantation
• Ort Quelle: Hagerstown, Md. : Lippincott Williams & Wilkins, 1963
• Jahr Quelle: 2021
• Band/Heft Quelle: 105(2021), 8 vom: Aug., Seite 1869-1880
• ISSN Quelle: 1534-6080
• DOI: doi:10.1097/TP.0000000000003513
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 177353162X

Abstract

Export - Background. Facial vascularized composite allotransplantation (fVCA) represents a reconstructive approach that enables superior improvements in functional and esthetic restoration compared with 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 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.