Recipient Selection Criteria for Facial Transplantation: A Systematic Review
Bachar F. Chaya, Augustus ParkerRicardo Rodriguez-Colon, Yvonne Hao, Keerthi Kurian, Jorge Trilles, Daniel Boczar,Hilliard Brydges, Eduardo D. Rodriguez
Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
Background: Recipient selection is an important determinant of surgical outcomes in facial transplantation (FT). Appropriately, each FT program develops their own guidelines for recipient selection criteria. The objective of this study is to provide a single resource of the recipient selection criteria used by established FT programs. Such information could be useful in distinguishing areas of FT that are well understood from those that could benefit from further exploration.
Methods: We performed a systematic review of the scientific literature from inception to June 18, 2021, using Pubmed, Embase, Cochrane Library, and Scopus to identify articles pertaining to recipient selection criteria. Clinical trials were identified through the Clinicaltrials.gov registry. US and international program websites were reviewed for patient-facing information.
Results: Our systematic review yielded 90 suitable articles, 8 clinical trials, and 7 program websites containing the recipient selection criteria of 23 different FT programs. Table 1 displays the positions of established FT programs on categorical recipient selection criteria. Of these, psychosocial stability and medical compliance were reported as inclusion criteria by almost every program. The majority of programs agreed on exclusion criteria such as positive human immunodeficiency viral status (HIV+), preexisting, and positive hepatitis C viral status (HCV+). Positions were more variable for recipient selection criteria such as a history of self-inflicted gunshot wounds and cytomegalovirus donor-recipient viral status mismatch. There were recipient criteria that were rarely addressed, such as blindness. Notably, programs would change their positions over time, with programs originally excluding HCV+ or blind patients later performing FT in such populations.
Conclusion: FT programs have dynamic guidelines that adapt concurrently with the evolution of the field. Most FT programs have reported on their recipient selection criteria to some degree. Commonalities exist between their guidelines, which may reflect a currently unaddressed but present consensus on certain recipient criteria. The rationale behind a programís specific positions were rarely provided, and further discussion on the reasoning behind employing or changing recipient selection criteria could be useful in addressing those currently without agreement. Increasing the accessibility of recipient selection criteria on patient-facing program websites could help in the referral process for patients and their physicians.
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