ABSTRACT
Purpose: VCA transplantation has grown and changed, encountering challenges such as scarce funding sources and the COVID-19 pandemic. Method(s): The OPTN cohort includes 105 candidates listed and 62 recipients transplanted 7/4/14-10/31/21. Result(s): VCA candidates included 47 uterus, 26 upper limb (UL, 14 bilateral, 12 unilateral), 1 UL/face, 12 face, 1 scalp, 2 face/scalp, 1 trachea, 12 abdominal wall (AW), and 3 penis candidates. Waiting list additions increased in 2016 after uterus transplants began in the US. Head and neck and UL additions held relatively steady through 2019. The COVID-19 pandemic caused a decrease in VCA waiting list additions in 2020 - 1 AW, 1 uterus, and two UL candidates. In the first 10 months of 2021, 5 VCA candidates were added - 2 AW and 3 uterus candidates. In April 2020, 11 of 23 VCA candidates were inactive;on 10/31/2021, 8 of 21 were inactive. 62 candidates received 64 transplants (including 1 uterus re-transplant and 1 face/ UL transplant). Others refused transplant (n=7), became ineligible (n=4), could not be contacted (n=2), condition improved (n=1), were too sick (n=2), died (n=3), or were removed for other reasons (n=2). Median time on the waiting list for recipients was 217 days (IQR: 76.0-404.25 days). VCA transplants in the U.S. 7/3/14-10/31/21 include 14 UL (9 bilateral;5 unilateral), 9 face, 1 UL/face, 1 scalp, 1 trachea, 2 AW, 2 penis, and 33 uterus (12 deceased donor;21 living donor). In 2016, VCA shifted from mostly UL and face to a larger proportion of uterus transplants. UL and face transplants decreased in 2017, then increased and held steady through 2019. VCA transplants decreased in 2020 with the COVID-19 crisis and included 2 uterus transplants, the first U.S. face re-transplant, and the first successful UL/face transplant in the U.S. In the first 10 months of 2021, 2 living donor uterus, 1 bilateral UL, and the first trachea transplant in the US occurred. Out of 62 recipients, 21 were funded by the hospital, 15 by donations, 7 by Medicare/ Medicaid, 1 by Dept of Veterans Affairs, 3 by private insurance, and 2 by recipient. Conclusion(s): VCA transplantation continues to faces challenges such as the COVID-19 pandemic and chronic issues such as funding sources, but has shown signs of resilience in 2021. (Figure Presented).
ABSTRACT
Purpose: Vascularized Composite Allograft (VCA) transplantation has grown and changed rapidly in the past several years. This study investigates VCA waiting list and transplant trends in the U.S. Methods: We used OPTN VCA waiting list data from July 3, 2014 through November 15, 2020 and OPTN VCA transplant data from January 1 1998 through November 15, 2020. Results: Since the OPTN implemented the VCA waiting list on July 3, 2014, 99 candidates have been registered on the waiting list through November 15, 2020. VCA candidates were 60.6% female, 79.8% white, and 78.8% under 45 years old, but characteristics varied by organ type. The size of the VCA waiting list increased gradually over several years, largely due to the introduction of uterus transplants. In the past year, however, existing registrations for upper limb and head and neck candidates held steady while uterus registrations declined. New registrations were notably lower in 2020, likely due to the COVID-19 crisis. As of 11/15/20, the OPTN VCA waiting list included 4 head and neck (20%), 6 upper limb (30%), 4 abdominal wall (20%), and 6 uterus (30%) candidates. Median days on the list for those waiting for a deceased donor organ on 11/15/20 was 771 days (IQR: 524.8 - 971.0) - a large increase compared with analyses at the same time in 2019. Median days on the VCA waiting list for those transplanted with a deceased donor organ was 193 days (IQR: 71.25 - 376.5). A total of 109 VCA recipients have received VCA transplants in the US, including 59 since 7/3/14: 8 bilateral upper limb, 5 unilateral upper limb, 10 face, 1 scalp, 2 abdominal wall, 31 uterus (12 deceased donor;19 living donor), and 2 penis transplants. Conclusions: Continued monitoring of VCA trends is needed to support VCA donation and transplantation.