Clinical Outcomes, Rejection Patterns, and Immunosuppressive Strategies in Vascularized Composite Allotransplantation: A PRISMA-Based Systematic Review

I Gusti Putu Hendra Sanjaya (RSUP Prof dr. I.G.N.G. Ngoerah)
Agus Roy Rusly Hariantana Hamid (RSUP Prof dr. I.G.N.G. Ngoerah)
Gede Wara Samsarga (RSUP Prof dr. I.G.N.G. Ngoerah)
Shita Diwyani Sudarsa (RSUP Prof dr. I.G.N.G. Ngoerah)
Astrinita Lestari Suyata (RSUP Prof dr. I.G.N.G. Ngoerah)
Chandra Wijaya Setiawan (Universitas Udayana & RSUP Prof dr. I.G.N.G. Ngoerah)

Indonesian Journal of Global Health Research
Vol. 8 No. 4 (2026): Indonesian Journal of Global Health Research

Vascularized composite allotransplantation (VCA) is an innovative reconstructive option for patients with complex tissue loss involving the face, upper extremities, and other anatomical structures. This systematic review aimed to synthesize evidence on clinical outcomes, rejection patterns, and immunosuppressive strategies in VCA. A systematic review was conducted following the PRISMA framework. Studies published between 2021 and 2026 evaluating VCA, particularly hand and face transplantation, were identified using relevant keywords and MeSH-related terms, including VCA, hand transplantation, face transplantation, immunosuppression, rejection, and graft survival. VCA provides significant functional, sensory, aesthetic, and psychosocial benefits, contributing to improved daily activities and quality of life. Acute cellular rejection was the most frequently reported immunological complication, particularly during the early post-transplant period. Antibody-mediated and chronic rejection were less common but could contribute to progressive graft dysfunction and loss. VCA offers promising functional and psychosocial outcomes with generally favorable short- to medium-term graft survival. However, rejection and the long-term morbidity associated with lifelong immunosuppression remain major clinical challenges.