Outcomes after hand and upper extremity transplantation
- 1k Downloads
Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify. Despite encouraging functional outcomes, current immunosuppressive regimens with their deleterious side-effect profile remain a major concern for a life-changing but not life-saving type of transplant. In addition, a growing number of recipients with progressively longer follow-up prompt the need to investigate potential long-term sequelae, such as chronic rejection. This review will discuss the current state of HUET, summarizing outcome data on graft survival, motor and sensory function, as well as immunosuppressive treatment. The implications of these findings for VCA in terms of achievements and challenges ahead will then be discussed.
Conflict of interest
The authors declare that they have no competing interests.
- 6.Morales I DA, Kaufman C, et al. What can we do when complications ensue? Round table discussion with case illustrations. In: IHCTAS 2013: 11th Meeting of the International Hand and Composite Tissue Allotransplantation Society. Wroclaw, Poland.; 2013.Google Scholar
- 11.Azari K: Speed update on the world experience on hand transplantation. In: IHCTAS 2013: 11th Meeting of the International Hand and Composite Tissue Allotransplantation Society. Wroclaw, Poland; 2013.Google Scholar
- 12.Lee WP: Reconstructive surgery: The evolution to VCA. Functional outcomes and complications. In: 7th Biennal Meeting of the World Society for Reconstructive Microsurgery. Chicago, Ill.; 2013.Google Scholar
- 22.Bernardon L, Gazarian A, Petruzzo P, Packham T, Guillot M, Guigal V, Morelon E, Pan H, Dubernard JM, Rizzo C, et al. Bilateral hand transplantation: Functional benefits assessment in five patients with a mean follow-up of 7.6 years (range 4-13 years). J Plast Reconstr Aesthet Surg. 2015;68(9):1171–83.CrossRefGoogle Scholar
- 27.Shores J, Brandacher G, Gorantla VS, Schneeberger S, Losee JE, Lee WP: A Summary of the Functional Outcomes Following Transplantation of 8 Hands/Upper Extremities in 5 Patients with an Innovative Cell-based Single Drug Immunotherapy Protocol. Paper presented at: 67th Annual Meeting of the American Society for Surgery of the Hand; September 6-8, 2012; Chicago, Ill. 2012.Google Scholar
- 31.Petruzzo P, Dubernard JM, Lanzetta M The international registry on hand and composite tissue allotransplantation (IRHCTT). presented at the ASRT meeting in Chicago, November 4th, 2016 2016.Google Scholar
- 34.Diaz-Siso JR, Fischer S, Sisk GC, Bueno E, Kueckelhaus M, Talbot S, Carty MJ, Treister NS, Marty F, Milford EL, et al. Initial experience of dual maintenance immunosuppression with steroid withdrawal in vascular composite tissue allotransplantation. Am J Transplant. 2015;15(5):1421–31.CrossRefGoogle Scholar
- 40.Pestana JO, Grinyo JM, Vanrenterghem Y, Becker T, Campistol JM, Florman S, Garcia VD, Kamar N, Lang P, Manfro RC, et al. Three-year outcomes from BENEFIT-EXT: a phase III study of belatacept versus cyclosporine in recipients of extended criteria donor kidneys. Am J Transplant. 2012;12(3):630–9.CrossRefGoogle Scholar
- 41.Grahammer J, Zelger B, Muehlbacher A, Schneeberger S, Weissenbacher A: Belatacept in hand transplantation - effectiveness and pitfalls. In: American Society for Reconstructive Transplantation 5th Biennial Meeting. Chicago; 2016.Google Scholar
- 47.Salminger S, Sturma A, Roche AD, Hruby LA, Paternostro-Sluga T, Kumnig M, Ninkovic M, Pierer G, Schneeberger S, Gabl M, et al. Functional and psychosocial outcomes of hand transplantation compared with prosthetic fitting in below-elbow amputees: a multicenter cohort study. PLoS One. 2016;11(9):e0162507CrossRefGoogle Scholar
- 48.Salminger S, Sturma A, Roche A: Functional comparison of hand transplantation and prosthetic fitting in below-elbow amputees. In: American Association for Hand Surgery (AAHS) Annual Meeting. 2015.Google Scholar