Table 1:

Current success and challenges in VCA

Achievements	Challenges
Excellent esthetic and functional outcome	Minimization of immunosuppression, tolerance induction
Multidisciplinary approach	Protocols for sensitized patients
Recognition as organ, regulated by OPTN	Improved monitoring
Excellent patient and graft survival	Mechanisms of rejection Acute cellular and humoral rejection
	Acute cellular and humoral rejection
	Chronic graft deterioration
	Nerve regeneration
	Definition of acceptable ischemic times
	Refined organ preservation

VCA = Vascularized composite tissue allotransplantation, OPTN = Organ Procurement and Transplantation Network