*Purpose: Characterize patterns in VCA transplantation in the U.S.

*Methods: Analyses include all VCA recipients in the U.S through October 2018 and all VCA candidates between July 2014 and October 2018.

*Results: Since the July 2014 implementation of the Organ Procurement and Transplantation Network (OPTN) VCA waiting list, 25 VCA recipients have received deceased donor VCA transplants (6 bilateral upper limb, 4 unilateral upper limb, 6 face, 1 scalp, 2 abdominal wall, 4 uterus, and 2 penis), and 9 received living donor uterus transplants. The VCA recipients were 44.4% male, 77.8% white, and 77.8% under 45 years. VCA transplant activity has shifted from predominantly upper limb, face, and abdominal wall transplants in the early years to a notable proportion of uterus transplants since 2016 (Figure 1). This transplant activity resulted from 72 candidates listed on the VCA waiting list since July 2014. VCA registrations increased in 2016 after uterus and penis transplants were introduced in the U.S. and increased again in early 2018 when face and uterus registrations increased (Figure 2). Time on the waiting list for VCA candidates varies greatly, with some candidates receiving deceased donor transplants quickly and others waiting more than three years (Figure 3). Median time on the list for those transplanted was 151.5 days (IQR: 67.5 – 373.0).

*Conclusions: Continued monitoring of transplant and waiting list trends is needed to support VCA donation and transplantation.

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