Pediatric Upper Extremity Vascularized Composite Allotransplantation-Progress and Future

被引：0

作者：

Zuo, Kevin J. ^{[1
,2
]}

Gold, Anna ^{[3
,4
]}

Shaul, Randi Zlotnik ^{[5
,6
]}

Ho, Emily S. ^{[1
,7
]}

Borschel, Gregory H. ^{[1
,2
]}

Zuker, Ronald M. ^{[1
,2
]}

机构：

[1] Hosp Sick Children, Div Plast & Reconstruct Surg, Toronto, ON, Canada

[2] Univ Toronto, Hosp Sick Children, Dept Surg, Div Plast & Reconstruct Surg, 555 Univ Ave, Toronto, ON M5G 1X8, Canada

[3] Hosp Sick Children, Dept Psychol, Toronto, ON, Canada

[4] Hosp Sick Children, Transplant & Regenerat Med Ctr, Toronto, ON, Canada

[5] Hosp Sick Children, Dept Bioeth, Toronto, ON, Canada

[6] Univ Toronto, Dept Pediat, Toronto, ON, Canada

[7] Univ Toronto, Dept Occupat Sci & Occupat Therapy, Toronto, ON, Canada

来源：

CURRENT TRANSPLANTATION REPORTS | 2020年 / 7卷 / 04期

关键词：

Vascularized composite allotransplantation; Hand transplantation; Upper extremity transplantation; Amputation; Prosthesis; Immunosuppression; ULNAR NERVE INJURIES; CORTICAL REORGANIZATION; HAND TRANSPLANTATION; FOLLOW-UP; MOTOR; TACROLIMUS; ALLOGRAFT; SURVIVAL; SYSTEM; CORTEX;

D O I：

10.1007/s40472-020-00297-9

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Purpose of Review Since 1998, over 120 upper extremity transplants have been successfully performed around the world; however, the field of vascularized composite allotransplantation (VCA) continues to face various medical challenges and ethical controversies. This article summarizes the worldwide experience with transplantation of vascularized composite upper extremities in children and discusses the unique considerations facing potential pediatric VCA recipients. Recent Findings Three children have successfully received composite upper or lower extremity transplants, of which two involved isografts and one involved allografts. Numerous research and clinical advances relevant to VCA have been made, including patient screening, perioperative rehabilitation, allograft preservation and transportation, enhancement of nerve regeneration, understanding of cortical plasticity, and immunomodulatory strategies. Ethical and psychosocial issues remain at the forefront when evaluating potential pediatric VCA recipients. For ethically and rigorously screened pediatric patients with debilitating upper extremity absence, VCA is a compelling option to restore form and function and has a promising future.

引用

页码：260 / 269

页数：10