Back to 2025 Abstracts
The State of Post-Transplant Malignancies in Vascularized Composite Allotransplantation
Alexis K. Gursky
*, Allison Horn, Hailey P. Wyatt, Sachin Chinta, Alay R. Shah, Bruce E. Gelb, Daniel J. Ceradini, Eduardo Rodriguez
Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, NY
Background: Vascularized composite allotransplantation (VCA) restores complex defects when conventional reconstruction options are not feasible. Lifelong immunosuppression is required to prevent rejection; however, it can increase the risk of malignancy. This study reviews the prevalence, management, and outcomes of post-transplant malignancies in VCA recipients to guide surveillance and early detection strategies.
Methods: A systematic review included VCA recipients with post-transplant malignancies and excluded cases with non-malignant tumors, premalignant lesions, dysplasia, or pre-transplant malignancies without recurrence. Data on transplant details, immunosuppression, malignancy characteristics, treatment, and outcomes were collected. Kaplan-Meier analysis was used to assess survival.
Results: Twenty studies (2007-2024) reported 15 VCA recipients with 24 malignancies. Skin cancers (54%) and post-transplant lymphoproliferative disorder (PTLD) (25%) were the most common, and 23% of skin cancers developed on the allograft. The median time to malignancy was 1.9 years, and recurrence occurred in 40%. Most (80%) experienced at least one acute rejection episode before malignancy diagnosis. Remission was achieved in 53%, while 40% died from malignancy-related causes. Survival differed by malignancy type (p = 0.04), with 100% survival in patients with only skin cancer and 67% mortality in those with only PTLD. Kaplan-Meier analysis showed a trend toward improved survival in skin cancer patients compared to non-skin cancer patients; however, it was not statistically significant (p = 0.08).
Conclusion: Post-transplant malignancies in VCA recipients are a major concern, with skin cancer and PTLD being most common and a median onset under two years. Most skin cancers arose at non-allograft sites, supporting total-body skin exams, and high PTLD mortality emphasizes the need for early detection via consistent labs and follow-up. Future studies should compare malignancy rates in VCA to solid organ transplant populations to assess relative risk and VCA-specific patterns.
Back to 2025 Abstracts
