title: Successes and lessons learned after more than a decade of upper extremity and face transplantation.
abstract: OBJECTIVE
  This review aims to present the most recent updates on face and upper-extremity allotransplantation.
  
  
  RESULTS
  To date, 27 face and more than 89 upper-extremity allotransplantations have been performed. Both the face and hand transplants restored form, function and patients' social integration. The complications were comparable with solid organs; however, face transplantation, as well as the combination of face and double hand transplantation, presented with significant morbidity and mortality. Evidence of chronic rejection was confirmed in hand transplants, but it has not been reported yet for facial transplantation. Novel immunosuppressive protocols have allowed a decrease in the number and dosages of traditional immunosuppressants. With increased awareness that following face and hand transplantation, the return of function is more important than anatomical restoration of the missing parts, there has been an important shift in the ethical debate weighing the risks and benefits of face and hand allotransplantation.
  
  
  CONCLUSIONS
  Early results after face and upper extremity transplantation are promising, with 5-year survival rates greater than in solid organ transplants. However, these procedures still need to be closely monitored and the outcome data should be rigorously reported to the central patient registry database to allow continuous surveillance.
authors.affiliation: Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Siemionow
authors.forename: Bahar Bassiri
authors.initials: BB
authors.lastname: Gharb
authors.forename: Antonio
authors.initials: A
authors.lastname: Rampazzo
mesh_terms: D000328:Adult; D054445:Facial Transplantation / Q000009:adverse effects / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D063987:Hand Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D007167:Immunotherapy; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic; D012042:Registries; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery*; D055815:Young Adult