Bio-boosting transplants: a systematic review on biopolymers in vascular composite allotransplantation

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Vascularized composite allotransplantation (VCA) joins skin, muscle, bone, nerve, and vessels into a single graft that is both highly immunogenic and mechanically complex. Biopolymers, natural or synthetic, can provide structural scaffolding, localized drug release, and immune modulation. Although widely explored in solid-organ transplantation, their utility in VCA is poorly defined. We therefore conducted a systematic review to consolidate current evidence and map translational priorities. Methods Adhering to PRISMA 2020 and registered in PROSPERO (CRD420251039845), we searched PubMed, Web of Science, EMBASE, Cochrane Library, and Google Scholar through April 2025. Original studies evaluating biopolymers in any VCA-relevant setting ( in vitro , animal, or clinical) were eligible. Clinical quality was judged with the Newcastle-Ottawa Scale and pre-clinical studies with the SYRCLE tool. Given methodological heterogeneity, findings were narratively synthesized. Results Eleven studies published between 2014 and 2024 fulfilled inclusion criteria. Collectively, they demonstrate that biopolymers, ranging from decellularized limb and auricular scaffolds to collagen-hydroxyapatite or polycaprolactone bone substitutes, hyaluronic-acid-functionalized vascular grafts, chitosan- or alginate-based drug-eluting coatings, and extracellular-matrix (ECM) sheets delivering cytotoxic T

Evidence level

Relatively higher-quality human studies compared with other topics in this database, e.g. multiple RCTs or systematic reviews. This does not mean it is standard or approved care.

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