Is Lower Extremity Transplantation a Superior Alternative to Prostheses? No—At Least Not Yet

Abstract

This paper reviews previously attempted cases of lower extremity vascularized composite allotransplantation (VCA), critically assesses the challenges associated with this procedure, and highlights alternative approaches to restore function for patients with lower limb loss. Despite progress in the field of upper extremity transplantation, attempts at lower extremity transplantation have resulted in zero successes. Major hurdles that must be overcome prior to future attempts include, but are not limited to, large motor nerve regeneration and immunosuppression-related complications. For those patients unable to achieve satisfactory function with traditional prostheses, alternative strategies involving osseointegration, active prostheses, and advanced human-machine interfaces provide improved function with a more favorable risk/benefit profile. Given the uncertain functional outcomes and considerable surgical and immunosuppression related risks, lower extremity VCA is far from being a superior alternative to advanced or even traditional prostheses. We believe the transplant community should focus on upper extremity transplantation and revisit this topic as further advances in the field are made.