Background
Current knowledge of the impact of facial vascularized composite allograft (VCA) procurement on the transplantation outcomes of the concomitantly recovered solid organs is limited to isolated case reports and short-term results. Here we report on a nationwide analysis of facial allograft donor surgery experience and long-term outcomes of the concomitantly recovered solid organs and their recipients.
Methods
There were 10 facial VCA procurements between December 2008 and October 2014. We identified the population of subjects who received solid organs from these 10 donors using the Scientific Registry of Transplant Recipients. We retrospectively reviewed operative characteristics, intra-operative parameters, and postoperative outcomes.
Results
Six of 10 donor surgeries were performed at outside institutions, all on brain-dead donors. Mean operative duration for facial VCA recovery was 69 hours (range 4 – 1325 hours). A total of 36 solid organs were recovered and transplanted into 35 recipients. Survival rates for kidney and liver recipients were 100 and 90% at a median follow-up of 33 and 275 months, respectively (range, 6–72 months). Graft survival rates for kidneys and livers were 15/16 (94%) and 9/10 (90%), respectively. Recipient and graft survival rates for hearts and lungs were 75% (n = 4) and 100% (n = 3) at mean follow-up time of 1475 and 16 months, respectively.
Conclusions
The advent and continued progress of vascularized composite allotransplantation has ushered in a new clinical arena in the field of transplantation. Critical to its advancement is the planning and safe execution of the donor procurement. Despite logistical and technical variation, we show that the procurement of facial VCA and simultaneous upper extremities does not appear to adversely affect the outcomes of transplant recipients of concomitantly recovered solid organs. Excellent coordination and communication between the organ recovery teams remains paramount with guidance and support from the respective organ procurement organization.