Evolution of Vascularized Composite Allotransplantation

Vascularized composite allotransplantation (VCA) is a relatively new and broad field allowing for reconstruction of complex tissue defects with allotransplantation of equivalent human parts. Major medical developments occurred over the past several decades resulting in satisfying aesthetic and functional outcomes of, for example, face, hand, abdominal wall, larynx, knee, scalp, penis, or uterus transplants. The composite nature of multiple tissues as well as significant immunogenicity of skin makes VCA unique as compared to solid organ transplantation (SOT). Given a small number of cases worldwide, major challenges still need to be addressed including agreement on indication and patient selection, prolongation of ischemia time, management of acute and chronic rejection, reduction of long-term toxicity of immunosuppressive medications, and potentially tolerance induction. A long-term goal facilitating mainstream adoption of VCA is the development of non-toxic, patient-specific immunosuppressive and/or tolerogenic strategies. In this chapter, we will discuss four key landmark papers on hand and face transplantation in context of VCA in general and presenting hereon the highlights as well as the history, challenges, and achievements to give an all-encompassing overview.