Evidence map›Paper›PMID 41752645›Full record

ReviewMedicina (Kaunas, Lithuania)2026

Vascularised Composite Allotransplantation: Emerging Applications in Reconstructive Surgery and Solid Organ Transplantation.

Cian M Hehir, Michael O'Connor, Iulia Marinescu, Fungai Dengu, Henk P Giele, Roisin T Dolan

Abstract readReview
In one paragraph

Review in Medicina (Kaunas, Lithuania), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Cian M HehirTissue Engineering Research Group (TERG), Royal College of Surgeons in Ireland, 123 St. Stephen's Green, D02 YN77 Dublin, Ireland.ORCID 0000-0001-8437-1447
Michael O'ConnorDepartment of Surgery, Royal College of Surgeons, 123 St. Stephen's Green, D02 YN77 Dublin, Ireland.
Iulia MarinescuDepartment of Plastic & Reconstructive Surgery, St. Vincent's University Hospital, Elm Park, D04 T6F4 Dublin, Ireland.
Fungai DenguDepartment of Hepatobiliary & Transplant Surgery, St. Vincent's University Hospital, Elm Park, D04 T6F4 Dublin, Ireland.
Henk P GieleDepartment of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford OX3 9DU, UK.ORCID 0000-0003-2017-5193
Roisin T DolanDepartment of Plastic & Reconstructive Surgery, St. Vincent's University Hospital, Elm Park, D04 T6F4 Dublin, Ireland.

Funding

Royal College of Surgeons in Ireland 24225A008
6 · The paper itself

Abstract

Vascularised composite allotransplantation (VCA) has an evolving role in the reconstruction of complex functional and aesthetic deficits non-amenable to autologous or implant-based reconstructive modalities. International applications of VCA span upper extremity, face, abdominal wall, uterus, and penile transplantation, with more than 300 procedures performed worldwide. Among these, abdominal wall transplantation has uniquely contributed to the development of the sentinel skin flap (SSF) concept, in which solid organ transplant patients undergo simultaneous transplantation of a solid organ and a donor-derived vascularised skin flap, with the skin component of the SSF being trialled internationally as a means of monitoring for rejection within the solid organ allograft. Despite growing clinical success, VCA continues to face substantial barriers to wider adoption. Acute rejection remains highly prevalent, affecting up to 89% of recipients, with significant morbidity linked to intensive systemic immunosuppression. Challenges are further amplified by the unique immunological heterogeneity of composite grafts, ethical concerns surrounding identity-linked tissues, and the lack of standardised outcomes reporting across VCA subtypes. Advances in machine perfusion technologies and emerging cellular and biomaterial-based immunomodulation strategies show promise in reducing immunosuppression burden and improving graft longevity. This review outlines the current state of VCA, including clinical applications, outcomes, and mechanistic insights from pre-clinical studies, while highlighting key ethical considerations and evolving regulatory frameworks. Future progress will depend on standardised reporting systems, improved donor-recipient matching, better understanding of ischemia-reperfusion injury, and the development of next-generation immunosuppressive/immuno-modulatory therapies. Collectively, these innovations position VCA as a rapidly advancing field with significant potential to redefine reconstructive and transplant surgery.

Indexed as

Organ TransplantationPlastic Surgery ProceduresVascularized Composite AllotransplantationGraft RejectionHumansallograftreconstructive microsurgerysentinel skin flap (SSF)vascularised composite allotransplantation (VCA)

Identifiers

PMID41752645
PMCPMC12941565

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.