HAS VASCULARIZED COMPOSITE ALLOTRANSPLANTATION (VCA) REACHED CRITICAL MASS?

Kadiyala Ravindra¹, Scott Hollenbeck¹, Detlev Erdmann¹, Julie Hudson¹, Debra Sudan¹.

¹Department of Surgery, Duke University, Durham, NC, USA.

Introduction: The first successful hand transplantation was performed in 1998. There has been a steady increase in the numbers and types of VCAs performed since then. We reviewed the current reports in literature and presentations at the recent scientific meetings to determine the acceptance of the procedure.

Materials and Methods: Analysis of data obtained from the International Hand Transplant registry publications and Pubmed search was used. Data including the type of procedure, number of centers performing VCA and the number per year over the past decade was determined.

Results: The number of centers performing CTA: Europe 10, Asia 8, North America 6 and South America 1. The number of centers that have performed 2 or more procedures are less: 4 in Asia, 8 in Europe and 4 in the United States.

The annual volume of clinical CTA has shown fluctuation with only a slow rate of growth. However the last year has seen a spurt of activity with nearly 16 procedures being reported. The number of hand transplants per year averaged 3 but has risen to 10 in 2010. Face transplants, being a recent innovation, have shown a similar increase in the past year. Other CTAs have not shown wide application most of the procedures were performed in only 3 centers: Miami (abdominal wall), Munau, Germanay (Knee) and Bogota, Columbia (larynx). However, there has been a steady increase in the scientific literature during this period.

Conclusions: The field of VCA has shown a steady growth over the past 12 years and has registered increased clinical activity in the last year. With more centers developing composite tissue programs, the field is likely to grow exponentially in the next decade. Thus the initial ethical dilemmas and concerns of safety and feasibility have passed and the field appears to have attained critical mass.