OPTN Vascularized Composite Allograft Waiting List: Current Status and Trends in the United States

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BackgroundVascularized composite allograft (VCA) transplantation is a developing area in the field of transplantation.MethodsThis study used Organ Procurement and Transplantation Network (OPTN) VCA waiting list and transplant data from July 3, 2014 through February 28, 2018, to characterize the OPTN VCA waiting list in terms of composition, removal patterns, waiting time, resulting transplants, and trends over time.ResultsBetween implementation of the OPTN VCA waiting list on July 3, 2014 and February 28, 2018, 54 candidates—53.7% were male, 79.6% were white, and 70.4% aged 18 to 44 years—were added to the OPTN VCA waiting list. Of these, 22 received deceased donor VCA transplants (6 bilateral upper limb, 4 unilateral upper limb, 5 craniofacial, 1 scalp, 1 abdominal wall, 1 penile, and 4 uterine), and 6 received living donor uterine transplants. Registrations increased in 2016 after uterine and penile transplants were introduced in the United States, resulting in a large shift in the composition of the VCA waiting list. Waiting times for VCA candidates vary greatly, with some VCA candidates receiving deceased donor transplants quickly and others waiting more than 3 years before transplantation.ConclusionsThe field of VCA transplantation and the composition of the OPTN VCA waiting list are evolving rapidly. Additional research is needed to understand these changes and investigate whether differences in need or differences in access have resulted in the variation seen on the VCA waiting list.

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