title: Pediatric vascularized composite allotransplantation.
abstract: BACKGROUND
  Vascularized composite allotransplantation (VCA) has experienced a growing acceptance, which has led to a debate centered on extending the indications of the procedure to include pediatric patients. The aim of this article was to discuss such indications based on the evidence in pediatric solid organ transplantation, reconstructive surgery in children, and VCA in adult patients.
  
  
  METHODS
  Papers published on the outcomes of pediatric solid organ transplantation, growth after replantation of extremities, vascularized autologous tissue transfer, craniofacial surgery, orthognathic procedures, facial fractures, and outcomes after repair of peripheral nerves in children were reviewed.
  
  
  RESULTS
  Although the outcomes of solid organ transplantation in children have improved, the transplanted organs continue to have a limited lifespan. Long-term immunosuppressive therapy exposes the patients to an increased lifetime risk of infections, diabetes, hypertension, dyslipidemia, cardiovascular disease, and malignancy. Growth impairment and learning disabilities are other relevant drawbacks, which affect the pediatric recipients. Nonadherence to medication is a common cause of graft dysfunction and loss among the adolescent transplant recipients. Rejection episodes, hospitalizations, and medication adverse effects contribute negatively to the quality of life of the patients. Although normal growth after limb transplantation could be expected, pediatric facial transplant recipients may present with arrest of growth of transplanted midfacial skeleton.
  
  
  CONCLUSIONS
  Considering the non-life-threatening nature of the conditions that lead to eligibility for VCA, it is suggested that it is premature to extend the indications of VCA to include pediatric patients under the currently available immunosuppressive protocols.
authors: From the Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH.
authors: Gaby
authors: G
authors: Doumit
authors: Bahar Bassiri
authors: BB
authors: Gharb
authors: Antonio
authors: A
authors: Rampazzo
authors: Francis
authors: F
authors: Papay
authors: Maria Z
authors: MZ
authors: Siemionow
authors: James E
authors: JE
authors: Zins
mesh_terms: D000293:Adolescent; D002648:Child; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D010372:Pediatrics; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D063986:Vascularized Composite Allotransplantation / Q000009:adverse effects / Q000379:methods
chemical_list: D007166:Immunosuppressive Agents