DESCRIPTION
Composite tissue allotransplantation (CTA) is the transfer of a composite of different tissues from one person to another person. Tissues may include skin, connective tissue, muscle, bone, and/or nerve. Composite tissue allotransplantation procedures are complex and involve a series of operations using a rotating team of specialists. It has been proposed for individuals who have suffered severe disfiguring facial trauma. The CTA procedure may be referred to by the more common lay term, face transplant. It has also been proposed as a restorative procedure in individuals with hand amputations who are dissatisfied with the appearance or function of a prosthetic hand.
Unlike most solid organ transplantations (e.g., kidney and heart transplants), composite tissue allotransplantation is not lifesaving. CTA is viewed in context of quality of life. CTA is not without risk including the potential challenges associated with life-long immunosuppression and graft loss. Potential adverse impact on quality of life must be considered if transplant outcome does not meet expectations both in aesthetics and/or function. To date, only a limited number of individuals worldwide have undergone the procedure and data are not sufficient to determine whether the potential benefits outweigh the potential risks (e.g., surgical complications, long-term immunosuppression, opportunistic infections).
POLICY
Composite tissue allotransplantation of the hands and/or face is considered investigational.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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SOURCES
Aycart, M., Kiwanuka, H., Krezdorn, N., Alhefzi, M., Bueno, E., Pomahac, B., & Oser, M. (2017). Quality of life after face transplantation: outcomes, assessment tools, and future directions. Plastic and Reconstructive Surgery, 139 (1), 194-203. Abstract retrieved October 12, 2017 from PubMed database.
Barret, J. (2013). From partial to full-face transplantation: Total ablation and restoration, a change in the reconstructive paradigm. International Journal of Surgery, 12, 109-112. (Level 2 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (9:2023). Composite tissue allotransplantation of the hand and face (7.03.13). Retrieved January 19, 2024 from www.bcbsaoca.com/eps/. (9 articles and/or guidelines reviewed)
Breidenbach, W.C., Meister, E.A., Becker, G.W., Turker, T., Gorantla, V.S., Hassan, K., & Kaplan, B. (2016). A statistical comparative assessment of face and hand transplantation outcomes to determine whether either meets the standard of care threshold. Plastic and Reconstructive Surgery, 137(1), 214e-222e. Abstract retrieved January 7, 2016 from PubMed database.
Daneshgaran, G., Stern, C.S., & Garfein, E.S. (2019). Reporting practices on immunosuppression and rejection management in face transplantation: A systematic review. Journal of Reconstructive Microsurgery, 35 (9), 652-661. Abstract retrieved May 27, 2020 from PubMed database.
Fischer, S., Kueckelhaus, M., Pauzenberger, R., Bueno, M., & Pomaha, B. (2015). Functional outcomes of face transplantation. American Journal of Transplantation, 15, 220-233. (Level 4 evidence)
Infante-Cossio, P., Barrera-Pulido, F., Gomez-Cia, T., Sicilia-Castro, D., Garcia-Perla-Garcia, A., Gacto-Sanchez, P., et al. (2013). Facial transplantation: a concise update. Medicina Oral, Patologia Oral Y Cirugia Bucal, 18 (2), e263-e271. (Level 2 evidence)
National Institute for Health and Care Excellence (NICE). (2011, March). Hand allotransplantation. Retrieved November 1, 2016 from http://www.nice.org.uk.
ORIGINAL EFFECTIVE DATE: 8/10/2013
MOST RECENT REVIEW DATE: 3/14/2024
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