Pediatric Vascular Composite Allograft Transplantation: Medical Considerations

Abstract

This report summarizes recent medical findings in the case of an allogenic bilateral hand-forearm allotransplantation in a previously immunocompromised child and discusses the implications for expanding vascular composite allotransplantation to non-immunocompromised pediatric candidates. A pediatric recipient of bilateral hand-forearm allotransplantation now over 2 years post-transplant has shown functional recovery that surpassed pre-transplant function, with evidence of somatosensory cortical reorganization. However, the child who was previously immunocompromised has required augmented immunosuppression and rehabilitation demands have been substantial. Pediatric vascular composite allotransplantation is surgically feasible, and short-term outcomes in the first case reveal the potential for functional benefits that exceed the pre-transplant state. Robust immunosuppression and its inherent risks must be clearly discussed with potential pediatric candidates and their families. Additionally, advanced planning for psychological and social support throughout the prolonged rehabilitation period is essential to optimize therapeutic engagement and academic learning.