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Outcomes after hand and upper extremity transplantation

  • Jaimie T. Shores
  • Veronika Malek
  • W. P. Andrew Lee
  • Gerald BrandacherEmail author
Tissue Regeneration or Regeneration of Engineered Tissue? Review Article
Part of the following topical collections:
  1. Tissue Regeneration or Regeneration of Engineered Tissue?

Abstract

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.

Notes

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Petruzzo P, Lanzetta M, Dubernard JM, Landin L, Cavadas P, Margreiter R, Schneeberger S, Breidenbach W, Kaufman C, Jablecki J, et al. The International registry on hand and composite tissue transplantation. Transplantation. 2010;90(12):1590–4.CrossRefGoogle Scholar
  2. 2.
    Petruzzo P, Dubernard JM. World experience after more than a decade of clinical hand transplantation: update on the French program. Hand Clin. 2011;27(4):411–6. viiCrossRefGoogle Scholar
  3. 3.
    Dubernard JM, Owen E, Herzberg G, Lanzetta M, Martin X, Kapila H, Dawahra M, Hakim NS. Human hand allograft: report on first 6 months. Lancet. 1999;353(9161):1315–20.CrossRefGoogle Scholar
  4. 4.
    Jones JW, Gruber SA, Barker JH, Breidenbach WC. Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team. N Engl J Med. 2000;343(7):468–73.CrossRefGoogle Scholar
  5. 5.
    Kanitakis J, Jullien D, Petruzzo P, Hakim N, Claudy A, Revillard JP, Owen E, Dubernard JM. Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation. 2003;76(4):688–93.CrossRefGoogle Scholar
  6. 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
  7. 7.
    Kaufman CL, Breidenbach W. World experience after more than a decade of clinical hand transplantation: update from the Louisville hand transplant program. Hand Clin. 2011;27(4):417–21. vii-viiiCrossRefGoogle Scholar
  8. 8.
    Schneeberger S, Gorantla VS, Brandacher G, Zeevi A, Demetris AJ, Lunz JG, Metes DM, Donnenberg AD, Shores JT, Dimartini AF, et al. Upper-extremity transplantation using a cell-based protocol to minimize immunosuppression. Ann Surg. 2013;257(2):345–51.CrossRefGoogle Scholar
  9. 9.
    Haddock NT, Chang B, Bozentka DJ, Steinberg DR, Levin LS. Technical implications in proximal forearm transplantation. Tech Hand Up Extrem Surg. 2013;17(4):228–31.CrossRefGoogle Scholar
  10. 10.
    Carty MJ, Hivelin M, Dumontier C, Talbot SG, Benjoar MD, Pribaz JJ, Lantieri L, Pomahac B. Lessons learned from simultaneous face and bilateral hand allotransplantation. Plast Reconstr Surg. 2013;132(2):423–32.CrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Dwyer KM, Webb AR, Furniss HS, Anjou KE, Gibbs-Dwyer JM, McCombe DB, Grinsell DG, Dickinson GF, Williams RA, Russell PA, et al. First hand transplant procedure in Australia: outcome at 2 years. Med J Aust. 2013;199(4):285–7.CrossRefGoogle Scholar
  14. 14.
    Schneeberger S, Landin L, Jableki J, Butler P, Hoehnke C, Brandacher G, Morelon E, Group ECW. Achievements and challenges in composite tissue allotransplantation. Transpl Int. 2011;24(8):760–9.CrossRefGoogle Scholar
  15. 15.
    Hautz T, Engelhardt TO, Weissenbacher A, Kumnig M, Zelger B, Rieger M, Rumpold G, Pierer G, Ninkovic M, Gabl M, et al. World experience after more than a decade of clinical hand transplantation: update on the Innsbruck program. Hand Clin. 2011;27(4):423–31. viiiCrossRefGoogle Scholar
  16. 16.
    Jablecki J. World experience after more than a decade of clinical hand transplantation: update on the Polish program. Hand Clin. 2011;27(4):433–42. viiiCrossRefGoogle Scholar
  17. 17.
    Cavadas PC, Landin L, Thione A, Rodriguez-Perez JC, Garcia-Bello MA, Ibanez J, Vera-Sempere F, Garcia-Cosmes P, Alfaro L, Rodrigo JD, et al. The Spanish experience with hand, forearm, and arm transplantation. Hand Clin. 2011;27(4):443–53. viiiCrossRefGoogle Scholar
  18. 18.
    Pei G, Xiang D, Gu L, Wang G, Zhu L, Yu L, Wang H, Zhang X, Zhao J, Jiang C, et al. A report of 15 hand allotransplantations in 12 patients and their outcomes in China. Transplantation. 2012;94(10):1052–9.CrossRefGoogle Scholar
  19. 19.
    Gorantla VS, Brandacher G, Schneeberger S, Zheng XX, Donnenberg AD, Losee JE, Lee WP. Favoring the risk-benefit balance for upper extremity transplantation--the Pittsburgh Protocol. Hand Clin. 2011;27(4):511–20. ix-xCrossRefGoogle Scholar
  20. 20.
    Shores JT, Lee WP, Brandacher G. Discussion: Lessons learned from simultaneous face and bilateral hand allotransplantation. Plast Reconstr Surg. 2013;132(2):433–4.CrossRefGoogle Scholar
  21. 21.
    Landin L, Bonastre J, Casado-Sanchez C, Diez J, Ninkovic M, Lanzetta M, del Bene M, Schneeberger S, Hautz T, Lovic A, et al. Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review. Transpl Int. 2012;25(4):424–32.CrossRefGoogle Scholar
  22. 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
  23. 23.
    Dellon AL, Curtis RM, Edgerton MT. Reeducation of sensation in the hand after nerve injury and repair. Plast Reconstr Surg. 1974;53(3):297–305.CrossRefGoogle Scholar
  24. 24.
    Cavadas PC, Ibanez J, Thione A. Secondary surgery for functional improvement after hand transplantation. Ann Plast Surg. 2011;67(4):421–2.CrossRefGoogle Scholar
  25. 25.
    Jablecki J, Kaczmarzyk L, Domanasiewicz A, Chelmonski A, Paruzel M, Elsaftawy A, Syrko M, Kaczmarzyk J. Result of arm-level upper-limb transplantation in two recipients at 19- and 30-month follow-up. Ann Transplant. 2012;17(3):126–32.CrossRefGoogle Scholar
  26. 26.
    Shores JT, Higgins JP, Lee WP. Above-elbow (supracondylar) arm transplantation: clinical considerations and surgical technique. Tech Hand Up Extrem Surg. 2013;17(4):221–7.CrossRefGoogle Scholar
  27. 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
  28. 28.
    Lanzetta M, Petruzzo P, Dubernard JM, Margreiter R, Schuind F, Breidenbach W, Nolli R, Schneeberger S, van Holder C, Gorantla VS, et al. Second report (1998-2006) of the international registry of hand and composite tissue transplantation. Transpl Immunol. 2007;18(1):1–6.CrossRefGoogle Scholar
  29. 29.
    Petruzzo P, Lanzetta M, Dubernard JM, Margreiter R, Schuind F, Breidenbach W, Nolli R, Schneeberger S, van Holder C, Kaufman C, et al. The international registry on hand and composite tissue transplantation. Transplantation. 2008;86(4):487–92.CrossRefGoogle Scholar
  30. 30.
    Lanzetta M, Petruzzo P, Margreiter R, Dubernard JM, Schuind F, Breidenbach W, Lucchina S, Schneeberger S, van Holder C, Granger D, et al. The international registry on hand and composite tissue transplantation. Transplantation. 2005;79(9):1210–4.CrossRefGoogle Scholar
  31. 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
  32. 32.
    Brandacher G, Lee WP, Schneeberger S. Minimizing immunosuppression in hand transplantation. Expert Rev Clin Immunol. 2012;8(7):673–83. quiz 684CrossRefGoogle Scholar
  33. 33.
    Ravindra KV, Ildstad ST. Immunosuppressive protocols and immunological challenges related to hand transplantation. Hand Clin. 2011;27(4):467–79. ixCrossRefGoogle Scholar
  34. 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
  35. 35.
    Breidenbach WC, Gonzales NR, Kaufman CL, Klapheke M, Tobin GR, Gorantla VS. Outcomes of the first 2 American hand transplants at 8 and 6 years posttransplant. J Hand Surg Am. 2008;33(7):1039–47.CrossRefGoogle Scholar
  36. 36.
    Petruzzo P, Testelin S, Kanitakis J, Badet L, Lengele B, Girbon JP, Parmentier H, Malcus C, Morelon E, Devauchelle B, et al. First human face transplantation: 5 years outcomes. Transplantation. 2012;93(2):236–40.CrossRefGoogle Scholar
  37. 37.
    Pomahac B, Pribaz J, Eriksson E, Annino D, Caterson S, Sampson C, Chun Y, Orgill D, Nowinski D, Tullius SG. Restoration of facial form and function after severe disfigurement from burn injury by a composite facial allograft. Am J Transplant. 2011;11(2):386–93.CrossRefGoogle Scholar
  38. 38.
    Diaz-Siso JR, Bueno EM, Sisk GC, Marty FM, Pomahac B, Tullius SG. Vascularized composite tissue allotransplantation--state of the art. Clin Transplant. 2013;27(3):330–7.CrossRefGoogle Scholar
  39. 39.
    Cendales L, Bray R, Gebel H, Brewster L, Elbein R, Farthing D, Song M, Parker D, Stillman A, Pearson T, et al. Tacrolimus to belatacept conversion following hand transplantation: a case report. Am J Transplant. 2015;15(8):2250–5.CrossRefGoogle Scholar
  40. 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. 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
  42. 42.
    Tuffs A. Munich surgeons perform world’s first transplantation of whole arms. BMJ. 2008;337:a1162CrossRefGoogle Scholar
  43. 43.
    Salminger S, Roche AD, Sturma A, Mayer JA, Aszmann OC. Hand transplantation versus hand prosthetics: pros and cons. Curr Surg Rep. 2016;4:8CrossRefGoogle Scholar
  44. 44.
    Ninkovic M, Weissenbacher A, Gabl M, Pierer G, Pratschke J, Margreiter R, Brandacher G, Schneeberger S. Functional outcome after hand and forearm transplantation: what can be achieved? Hand Clin. 2011;27(4):455–65. viii-ixCrossRefGoogle Scholar
  45. 45.
    Salminger S, Sturma A, Herceg M, Riedl O, Bergmeister K, Aszmann OC. [Prosthetic reconstruction in high amputations of the upper extremity]. Orthopade. 2015;44(6):413–8.CrossRefGoogle Scholar
  46. 46.
    Biddiss EA, Chau TT. Upper limb prosthesis use and abandonment: a survey of the last 25 years. Prosthet Orthot Int. 2007;31(3):236–57.CrossRefGoogle Scholar
  47. 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. 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
  49. 49.
    Blough DK, Hubbard S, McFarland LV, Smith DG, Gambel JM, Reiber GE. Prosthetic cost projections for servicemembers with major limb loss from Vietnam and OIF/OEF. J Rehabil Res Dev. 2010;47(4):387–402.CrossRefGoogle Scholar
  50. 50.
    Mathes DW, Schlenker R, Ploplys E, Vedder N. A survey of north american hand surgeons on their current attitudes toward hand transplantation. J Hand Surg Am. 2009;34(5):808–14.CrossRefGoogle Scholar
  51. 51.
    Leto Barone AA, Sun Z, Montgomery RA, Lee WP, Brandacher G. Impact of donor-specific antibodies in reconstructive transplantation. Expert Rev Clin Immunol. 2013;9(9):835–44.CrossRefGoogle Scholar
  52. 52.
    Kanitakis J, Karayannopoulou G, Lanzetta M, Petruzzo P. Graft vasculopathy in the skin of a human hand allograft: implications for diagnosis of rejection of vascularized composite allografts. Transpl Int. 2014;27(11):e118–23.CrossRefGoogle Scholar
  53. 53.
    Kanitakis J, Petruzzo P, Badet L, Gazarian A, Thaunat O, Testelin S, Devauchelle B, Dubernard JM, Morelon E. Chronic rejection in human vascularized composite allotransplantation (hand and face recipients): an update. Transplantation. 2016;100(10):2053–61.CrossRefGoogle Scholar
  54. 54.
    Kaufman CL, Ouseph R, Blair B, Kutz JE, Tsai TM, Scheker LR, Tien HY, Moreno R, Ozyurekoglu T, Banegas R, et al. Graft vasculopathy in clinical hand transplantation. Am J Transplant. 2012;12(4):1004–16.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Jaimie T. Shores
    • 1
  • Veronika Malek
    • 1
    • 2
  • W. P. Andrew Lee
    • 1
  • Gerald Brandacher
    • 1
    Email author
  1. 1.Department of Plastic and Reconstructive SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Ruprecht-Karls University Heidelberg Medical FacultyHeidelbergGermany

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