Department of Surgery, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York.
Department of Surgery, Division of Plastic and Reconstructive Surgery, Rutgers University, Newark, New Jersey.
J Surg Res. 2023 Jan;281:164-175. doi: 10.1016/j.jss.2022.08.023. Epub 2022 Sep 24.
Twenty three years after the first successful upper extremity transplantation, the role of vascularized composite allotransplantation (VCA) in the world of transplantation remains controversial. Face and upper extremity reconstruction via transplantation have become successful options for highly selected patients with severe tissue and functional deficit when conventional reconstructive options are no longer available. Despite clear benefit in these situations, VCA has a significant potential for complications that are more frequent when compared to visceral organ transplantation. This study intended to perform an updated systematic review on such complications.
MEDLINE database via PubMed, Embase and Cochrane Library were searched. Face and upper extremity VCA performed between 1998 and 2021 were included in the study. Relevant media and press conferences reports were also included. Complications related to face and upper extremity VCA were recorded and reviewed including their clinical characteristics and complications.
One hundred fifteen patients underwent facial (43%) or upper extremity (57%) transplantation. Overall, the surgical complication rate was 23%. Acute and chronic rejection was identified in 89% and 11% of patients, respectively. Fifty eight percent of patients experienced opportunistic infection. Impaired glucose metabolism was the most common immunosuppression-related complication other than infection. Nineteen percent of patients ultimately experienced partial or complete allograft loss.
Complications related to VCA are a significant source of morbidity and potential mortality. Incidence of such complications is higher than previously reported and should be strongly emphasized in patient consent process. Strict patient selection criteria, complex preoperative evaluation, consideration of alternatives, and thorough disclosure to patients should be routinely performed prior to VCA indication.
首例上肢成功移植 23 年后，血管化复合组织移植（VCA）在移植领域的作用仍然存在争议。当传统的重建方法不再可行时，通过移植对面部和上肢进行重建已成为严重组织和功能缺陷的高度选择患者的成功选择。尽管在这些情况下明显受益，但 VCA 具有比内脏器官移植更频繁发生的并发症的巨大潜在风险。本研究旨在对此类并发症进行更新的系统评价。
通过 PubMed、Embase 和 Cochrane Library 搜索 MEDLINE 数据库。研究纳入了 1998 年至 2021 年间进行的面部和上肢 VCA。还包括相关的媒体和新闻发布会报告。记录和回顾与面部和上肢 VCA 相关的并发症，包括其临床特征和并发症。
115 名患者接受了面部（43%）或上肢（57%）移植。总体而言，手术并发症发生率为 23%。分别有 89%和 11%的患者出现急性和慢性排斥反应。58%的患者发生机会性感染。除感染外，葡萄糖代谢受损是最常见的与免疫抑制相关的并发症。19%的患者最终经历了部分或完全同种异体移植物丢失。
与 VCA 相关的并发症是发病率和潜在死亡率的重要来源。此类并发症的发生率高于先前报道，应在患者同意过程中予以强调。在 VCA 指征之前，应常规进行严格的患者选择标准、复杂的术前评估、替代方案的考虑以及向患者进行全面披露。
