PURPOSE: Authors have speculated that vascularized composite allotransplantation recipients (VCAR) require greater maintenance immunosuppression than solid organ recipients due to skin's higher antigenicity. This has generated considerable debate, with patients theoretically exposed to increased therapeutic risks for non-life-saving procedures. Comparisons of VCAR and solid organ immunosuppression have not been reported.

METHODS: VCAR immunosuppression data were collected through a review of hand and face transplant literature. Kidney recipient (KR) data was obtained from an institutional review board-approved retrospective chart review. Prednisone and mycophenolate mofetil (MMF) doses were compared between VCAR and KR at predefined follow-up intervals (<1, 1-5, and >5 years). Tacrolimus target trough levels (TTTL) were compared at follow-up intervals of 1-5 and >5 years, and stratified into our institution's kidney transplant risk-based target ranges (4-6 ng/ml, 6-8 ng/ml) or higher (>8 ng/ml).

RESULTS: Immunosuppression data were available for 57 VCAR and 98 KR. There were no significant differences in prednisone doses between groups at all follow-up intervals. VCAR mean MMF dose was significantly greater at <1-year (1.71 ± 0.58 vs. 1.16 ± 0.55 gm/day; p=0.01). For VCAR, there was a significant difference (p=0.02) in TTTL distribution over the three predefined therapeutic ranges (4-6 ng/ml, 6-8 ng/ml and >8 ng/ml) between 1-5 years (24.0%, 20.0%, 56.0%, respectively) and >5 years (28.6%, 42.9%, 28.6%).

CONCLUSIONS: At longer follow-up, VCAR and KR receive comparable MMF/prednisone doses, and most VCAR are treated with TTTL similar to KR. Further study will be needed improve our understanding of VCA's complex risk/benefit ratio and help guide maintenance immunosuppression planning.

CITATION INFORMATION: Manjunath A., Cammarata M., Kantar R., Rifkin W., Jacoby A., Gelb B., Diaz-Siso R., Rodriguez E. Maintenance Immunosuppression Trends in Hand and Facial VCA Transplantation Am J Transplant. 2017;17 (suppl 3).

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