Source of Data

For this retrospective cohort study, we used the hospital information system of the Brigham and Women's Hospital (BWH), Boston, MA. The hospital information system database contains documentation of all in-house visits and respective blood chemistry and urine analyses, as well as scanned documentation of outpatient visits in other institutions, when available. We obtained clinical and laboratory data from 10 patients that received VCA and followed-up at the BWH.

We also included deidentified data from the International Registry on Hand and Composite Tissue Transplantation (IR), which compiles patient data from 24 participating international VCA centers.⁸ Data include pretransplant history and demographic characteristics, as well as surgical information, immunosuppressive induction therapy, and maintenance regimens. The VCA centers that subscribe to the registry update the information on their transplant recipients on an annual and voluntary basis.

The BWH cohort consisted of all 10 patients that received VCA at BWH, namely, 3 upper-extremity recipients and 7 face transplant recipients.

The IR cohort also included recipients of upper-extremity (60 patients) or facial transplantation (29 patients).