Recipient Selection Criteria for Facial Transplantation

Abstract

BackgroundRecipient selection is an important determinant of surgical outcomes in facial transplantation (FT). Appropriately, each FT program develops their own guidelines for recipient selection criteria. Currently, there is no resource to simultaneously assess and identify similarities and differences between these guidelines. Such information could be useful in distinguishing areas of FT that are well understood from those that could benefit from further exploration.MethodsWe performed a systematic review of the scientific literature from inception to June 18, 2021, using Pubmed, Embase, Cochrane Library, and Scopus to identify articles pertaining to recipient selection criteria. Clinical trials were identified through the Clinicaltrials.gov registry. United States and international program websites were reviewed for patient-facing information.ResultsOur systematic review yielded 90 suitable articles, 8 clinical trials, and 7 program websites containing the recipient selection criteria of 24 different FT programs. The most reported on recipient criteria were age, positive human immunodeficiency viral status (HIV+), positive hepatitis C viral status, psychosocial stability, and medical compliance. Other criteria were rarely addressed, such as blindness and recipient immune status.ConclusionsGuidelines among different face transplant programs are changing over time. We found consensus on certain recipient selection criteria, but the majority remain program or surgeon dependent, emphasizing that FT is still an evolving procedure. Although most programs reported on their recipient selection criteria, the rationale was often missing. Further discussion about recipient selection criteria and the reasoning behind employing or changing them will help advance the field.

Vascularized Composite Allotransplantation of the Hand

“…However, the recent development of direct-acting antivirals offers a cure for patients with chronic HCV: this development has led to updates in the policies of some SOT centers that have successfully conducted SOT in HCV patients 132,133 . While one FT center has updated its policy to remove HCV as an exclusion criterion, this study did not identify similar changes among any HT centers 14 . Hence, these new data may encourage the field of HT to continually reevaluate medical eligibility criteria, especially in an attempt to improve access to otherwise ineligible patients.…”

“…132,133 While one FT center has updated its policy to remove HCV as an exclusion criterion, this study did not identify similar changes among any HT centers. 14 Hence, these new data may encourage the field of HT to continually reevaluate medical eligibility criteria, especially in an attempt to improve access to otherwise ineligible patients. Programs did not agree regarding anatomic requirements for HT, and our findings showed that most centers offered unilateral HT only to address dominant hand injuries.…”

“…The methodology here presented was adapted from a previously published study on facial transplantation (FT) eligibility criteria. 14 Search term criteria are presented in Table 1. Both title and abstract as well as full-text screening were conducted by 2 independent reviewers (M.L., K.C.)…”

“…On July 5, 2022, the authors conducted a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines of MEDLINE, PubMed, Cochrane, and Scopus databases with no restriction on the time of publication. The methodology here presented was adapted from a previously published study on facial transplantation (FT) eligibility criteria 14 . Search term criteria are presented in Table 1.…”

Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment

“…The primary indication for face transplantation (FT) is restoration of the functional structures of the central face, which remain poorly reparable through traditional autologous methods. 1 Over the nearly 20-year history, of FT, surgeons have successfully transplanted a variety of structures, including the nose and nasal mucosa, lips and dentition, ears, neck, scalp, pharynx, and larynx. 2 FT has also proven valuable for the restoration of the eyelids, the function of which is integral to the maintenance of a healthy globe and limiting vision-related complications.…”