Background: Facial vascularized composite allotransplantation (fVCA) represents a reconstructive approach that enables superior improvements in functional and esthetic restoration compared to conventional craniomaxillofacial reconstruction. Outcome reports of fVCA are usually limited to short-term follow-up or single-center experiences. We merge scientific literature on reported long-term outcome data to better define the risks and benefits of fVCA. Methods: We conducted a systematic review of PubMed/MEDLINE databases in accordance with PRISMA guidelines. English full-text articles providing data on at least 1 unique fVCA patient, with ≥ 3 years follow-up, were included. Results: The search yielded 1812 articles, of which 28 were ultimately included. We retrieved data on 23 fVCA patients with mean follow-up of 5.3 years. More than half of the patients showed improved quality of life, eating, speech, and motor and sensory function following fVCA. On average, the patients had 1 acute cell-mediated rejection and infectious episode per year. The incidence rates of acute rejection and infectious complications were high within first year posttransplant but declined thereafter. Sixty-five percent of the patients developed at least 1 neoplastic and/or metabolic complication after transplantation. Chronic vascular rejection was confirmed in 2 patients, leading to allograft loss after 8 and 9 years. Two patient deaths occurred 3.5 and 10.5 years after transplant due to suicide and lung cancer, respectively. Conclusions: Allograft functionality and improvements in quality of life suggest a positive risk-benefit ratio for fVCA. Recurrent acute rejection episodes, chronic rejection, immunosuppression related complications, and heterogeneity in outcome reporting present ongoing challenges in this field. * Drs Kollar and Pomahac contributed equally to the study as last authors Financial Disclosure: Drs Kauke, Haug and Safi received financial support from the DFG ("Deutsche Forschungsgemeinschaft"). Dr Kollar was the recipient of the Plastic Surgery Foundation Research Fellowship Grant. Dr Pomahac received partial salary support from the U.S. Department of Defense under the award #W911QY-09-C-0216. Opinions, interpretations, conclusions, and recommendations are those of the authors and not of the Department of Defense. Disclaimer: The authors declare no conflicts of interest. Correspondence: Bohdan Pomahac, MD Roberta and Stephen R. Weiner Distinguished Chair in Surgery Director, Plastic Surgery Transplantation Professor of Surgery, Harvard Medical School Brigham and Women's Hospital Department of Surgery, Division of Plastic Surgery 75 Francis Street Boston, MA 02115, USA Telephone: +1-617-732-7796 E-mail: bpomahac@bwh.harvard.edu Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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