Chef de service,
Renal and Pancreas Transplantation
Hopital Edouard Herriot, Hospices Civils de Lyon;
Professor of Nephrology,
Université Claude Bernard Lyon 1
In 1998, the Lyon team ushered the new era of Vascularized Composite Allotransplantation (VCA) with the first successful unilateral human hand allotransplantation. The pioneering successes of upper extremity and face transplantation helped pave the way for other VCA such as abdominal wall, larynx, lower extremity, penis and uterus. We have witnessed a surge of new VCA programs across the Americas, Europe and Asia.
The International Hand and Composite Tissue Allotransplantation Society (IHCTAS) established in 1998 following the first clinical VCA in France is now the International Society of Vascularized Composite Allotransplantation (ISVCA). The new name of our society reflects its vision for excellence in education, research and advocacy in VCA. The most important goal for the ISVCA is leading the charge in breaking new barriers and expanding scope of practice across the world.
Two decades of experiences and insights confirm the life-changing benefits of upper extremity and craniofacial VCA in anatomic, functional or aesthetic restoration of patients suffering from devastating disabilities or disfigurements. It is encouraging to note that, across the majority of VCA, motor, sensory, immunologic, graft and patient survival outcomes have been outstanding compared to early results with other solid organ transplants. Recipients of upper extremity or face VCA have successfully regained personal and professional independence with activities of daily living, returned to employable status or reintegrated into society.
Despite these successes, chronic rejection, long-term complications of immunosuppression, and exit strategies in the event of graft failure remain key barriers to the future of our field.
Furthermore, in addition to surgical, immunological, and psychological hurdles, lack of financial support to sustain VCA remains a critical challenge across the world. An important strategic goal for the field is to achieve coverage by health authorities and insurance reimbursement to enable routine clinical availability. It is time for upper extremity and face VCA, with demonstrated outcomes and proven success to be recognized as standard of care procedures.
In addition to continuing its support in understanding the psychosocial aspects of VCA through the biennial Chauvet workgroup, the ISVCA will also foster meaningful dialogue and critical appraisal of the ethical impediments and controversies in VCA.
The ISVCA and the American Society of Reconstructive Transplantation (ASRT) will jointly identify working groups led by multidisciplinary VCA experts to recommend guidelines for diagnosis and definitions of chronic rejection, or graft success and failure. Such criteria are essential to standardize outcome metrics to validate new therapeutic approaches, selection of objective end points in clinical trials, assess quality of research grants and to lobby government or private insurance entities for financial support in VCA. The working groups will report their progress at each of the ASRT or ISVCA meeting to facilitate further debate required to establish consensus.
The ISVCA seeks to be a forum for our professional peers, patients and public. To serve this goal, the ISVCA web platform will be optimized in scope and functionality to serve as a multifaceted, easy to navigate portal for programmatic updates, patient experiences, standardized protocols, and clinical trial, research or training opportunities.
I welcome you to join the ISVCA as it leads the charge through multidisciplinary collaboration and international partnership to break new barriers and forge a bright future for the field.
Finally, it is my pleasure to announce that the 14th Congress of ISVCA will be held in New Delhi, India, on September 30–October 1, 2019.
Emmanuel Morelon, MD, PhD,