Hand Transplantation: The Innsbruck Experience

  • Stefan Schneeberger
  • Marina Ninkovic
  • Raimund Margreiter

Hand transplantation is currently the most controversially discussed issue in the field of clinical transplantation. After the first hand of the “new era” was transplanted in Lyon in 1998, the debate on whether hand transplantation is justified or not resulted in numerous debates in the scientific press and the public media. Subjective conclusions and recommendations rather than a scientific evaluation of the current results have resulted in polarization between those pro and those contra hand transplantation. Initial fears that the transplanted limbs might be irreversibly rejected early after transplantation and that function would be poor were disproved. Instead, 100% graft survival at 1 year after hand transplantation is superior to the outcome achieved in any type of solid organ transplantation. However, the side effects related to the immunosuppressive treatment, the uncertain long-term outcome, the limited number of recipients meeting the required criteria together with the high cost of surgery, rehabilitation, and immunosuppression may be responsible for the decreased activity seen in this field in recent years.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    S. E. Edgell, S. J. McCabe, W. C. Breidenbach, W. P. Neace, A. S. LaJoie, T. D. Abell, Different reference frames can lead to different hand transplantation decisions by patients and physicians, J Hand Surg [Am] 26(2), 196–200 (2001).CrossRefGoogle Scholar
  2. 2.
    S. McCabe, G. Rodocker, K. Julliard, W. Breidenbach, C. Marcel, M. V. Shirbacheh, J. Barker, Using decision analysis to aid in the introduction of upper extremity transplantation, Transplant Proc 30, 2783–2786 (1998).PubMedCrossRefGoogle Scholar
  3. 3.
    N. F. Jones, Concerns about human hand transplantation in the 21st century, J Hand Surg [Am] 27(5), 771–787 (2002).CrossRefGoogle Scholar
  4. 4.
    S. Hettiaratchy, M. A. Randolph, F. Petit, W. P. Lee, P. E. Butler, Composite tissue allotransplantation – a new era in plastic surgery? Br J Plast Surg 57(5), 381–391 (2004).PubMedCrossRefGoogle Scholar
  5. 5.
    W. P. Lee, Composite tissue transplantation: more science and patience needed, Plast Reconstr Surg 107(4), 1066–1070 (2001).PubMedCrossRefGoogle Scholar
  6. 6.
    S. Hettiaratchy, P. E. Butler, W. P. Lee, Lessons from hand transplantations, Lancet 357(9255), 494–495 (2001).PubMedCrossRefGoogle Scholar
  7. 7.
    M. Lanzetta, P. Petruzzo, R. Margreiter, J. M. Dubernard, F. Schuind, W. Breidenbach, S. Lucchina, S. Schneeberger, C. van Holder, D. Granger, G. Pei, J. Zhao, X. Zhang, The international registry on hand and composite tissue transplantation, Transplantation 79(9), 1210–1214 (2005).PubMedCrossRefGoogle Scholar
  8. 8.
    P. Petruzzo, L. Badet, M. Lanzetta, J. M. Dubernard, Concerns on clinical application of composite tissue allotransplantation, Acta Chir Belg 104, 266–271 (2004).PubMedGoogle Scholar
  9. 9.
    M. Lanzetta, P. Petruzzo, G. Vitale, S. Lucchina, E. R. Owen, J. M. Dubernard, N. Hakim, H. Kapila, Human hand transplantation: what have we learned? Transplant Proc 36, 664–668 (2004).PubMedCrossRefGoogle Scholar
  10. 10.
    G. Germann, Bilateral hand transplantation – indication and rationale, J Hand Surg [Br] 26, 521 (2001).Google Scholar
  11. 11.
    S. Schneeberger, B. Zelger, M. Ninkovic, R. Margreiter, Transplantation of the hand, Transplant Rev 100–107 (2005).Google Scholar
  12. 12.
    J. M. Dubernard, E. Owen, G. Herzberg, M. Lanzetta, X. Martin, H. Kapila, M. Dawahra, N. S. Hakim, Human hand allograft: report on first 6 months, Lancet 353(9161), 1315–1320 (1999).PubMedCrossRefGoogle Scholar
  13. 13.
    J. W. Jones, S. A. Gruber, J. H. Barker, W. C. Breidenbach, Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team, N Engl J Med 343, 468–473 (2000).PubMedCrossRefGoogle Scholar
  14. 14.
    J. M. Dubernard, P. Petruzzo, M. Lanzetta, H. Parmentier, X. Martin, M. Dawahra, N. S. Hakim, E. Owen, Functional results of the first human double-hand transplantation, Ann Surg 238, 128–136 (2003).PubMedCrossRefGoogle Scholar
  15. 15.
    R. Margreiter, G. Brandacher, M. Ninkovic, W. Steurer, A. Kreczy, S. Schneeberger, A double-hand transplant can be worth the effort! Transplantation 74, 85–90 (2002).PubMedCrossRefGoogle Scholar
  16. 16.
    S. Schneeberger, A. Kreczy, G. Brandacher, W. Steurer, R. Margreiter, Steroid- and ATG-resistant rejection after double forearm transplantation responds to campath-1H, Am J Transplant 4, 1372–1374 (2004).PubMedCrossRefGoogle Scholar
  17. 17.
    L. R. Scheker, A. Hodges, Brace and rehabilitation after replantation and revascularization, Hand Clin 17, 473 (2001).PubMedGoogle Scholar
  18. 18.
    G. F. Salvini, C. C. Perfetti, A new method of rehabilitation of the hand in hemiplegic patients. (preliminary results) Riv Neurobial. 17(1), 11–20 (1971).Google Scholar
  19. 19.
    S. Schneeberger, M. Ninkovic, M. Gabl, M. Ninkovic, H. Hussl, M. Rieger, W. Loescher, B. Zelger, G. Brandacher, H. Bonatti, T. Hautz, C. Boesmueller, H. Piza-Katzer, R. Margreiter, First forearm transplantation outcome at 3 years. Amer J Transplant 7(7), 1753–62 (2007 July).CrossRefGoogle Scholar
  20. 20.
    S. Schneeberger, M. Ninkovic, H. Piza-Katzer, M. Gabl, H. Hussl, M. Rieger, W. Loescher, B. Zelger, G. Brandacher, M. Ninkovic, H. Bonatti, C. Boesmueller, W. Mark, R. Margreiter, Status 5 years after bilateral hand transplantation, Am J Transplant. 6(4): 834–41 (2006).PubMedCrossRefGoogle Scholar
  21. 21.
    S. Schneeberger, S. Lucchina, M. Lanzetta, G. Brandacher, C. Bosmuller, W. Steurer, F. Baldanti, C. Dezza, R. Margreiter, H. Bonatti, Cytomegalovirus-related complications in human hand transplantation, Transplantation 80(4), 441–447 (2005).PubMedCrossRefGoogle Scholar
  22. 22.
    C. Brenneis, W. N. Loscher, K. E. Egger, T. Benke, M. Schocke, M. F. Gabl, G. Wechselberger, S. Felber, S. Pechlaner, R. Margreiter, H. Piza-Katzer, W. Poewe, Cortical motor activa-tion patterns following hand transplantation and replantation, J Hand Surg [Br] 30(5), 530–533 (2005).Google Scholar
  23. 23.
    P. Giraux, A. Sirigu, F. Schneider, J. M. Dubernard, Cortical reorganization in motor cortex after graft of both hands, Nat Neurosci 4, 691–692 (2001).PubMedCrossRefGoogle Scholar
  24. 24.
    J. Nanobashvili, C. Neumayer, A. Fugl, A. Punz, R. Blumer, M. Prager, M. Mittlbock, H. Gruber, P. Polterauer, E. Roth, T. Malinski, I. Huk, Ischemia/reperfusion injury of skeletal muscle: plasma taurine as a measure of tissue damage, Surgery 133, 91–100 (2003).PubMedCrossRefGoogle Scholar
  25. 25.
    M. R. Costanzo, D. C. Naftel, M. R. Pritzker, J. K. Heilman 3rd, J. P. Boehmer, S. C. Brozena, G. W. Dec, H. O. Ventura, J. K. Kirklin, R. C. Bourge, L. W. Miller, Heart transplant coronary artery disease detected by coronary angiography: a multiinstitutional study of preoperative donor and recipient risk factors. Cardiac Transplant Research Database, J Heart Lung Transplant 17, 744–753 (1998).PubMedGoogle Scholar
  26. 26.
    H. J. Eisen, E. M. Tuzcu, R. Dorent, J. Kobashigawa, D. Mancini, H. A. Valantine-von Kaeppler, R. C. Starling, K. Sorensen, M. Hummel, J. M. Lind, K. H. Abeywickrama, P. Bernhardt; RAD B253 Study Group, Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients, N Engl J Med 349(9), 847–858 (2003).PubMedCrossRefGoogle Scholar
  27. 27.
    D. Mancini, S. Pinney, D. Burkhoff, J. LaManca, S. Itescu, E. Burke, N. Edwards, M. Oz, A. R. Marks, Use of rapamycin slows progression of cardiac transplantation vasculopathy, Circulation 108(1), 48–53 (2003).PubMedCrossRefGoogle Scholar
  28. 28.
    J. C. Ruiz, J. M. Campistol, J. M. Grinyo, A. Mota, D. Prats, J. A. Gutierrez, A. C. Henriques, J. R. Pinto, J. Garcia, J. M. Morales, J. M. Gomez, M. Arias, Early cyclosporine a withdrawal in kidney-transplant recipients receiving sirolimus prevents progression of chronic pathologic allograft lesions, Transplantation 78(9), 1312–1318 (2004).PubMedCrossRefGoogle Scholar
  29. 29.
    T. S. Ikonen, J. F. Gummert, M. Hayase, Y. Honda, B. Hausen, U. Christians, G. J. Berry, P. G. Yock, R. E. Morris, Sirolimus (rapamycin) halts and reverses progression of allograft vascular disease in non-human primates, Transplantation 70(6), 969–975 (2000).PubMedCrossRefGoogle Scholar
  30. 30.
    J. M. Campistol, A. Gutierrez-Dalmau, J. V. Torregrosa, Conversion to sirolimus: a successful treatment for posttransplantation Kaposi's sarcoma, Transplantation 77(5), 760–762 (2004).PubMedCrossRefGoogle Scholar
  31. 31.
    G. E. Koehl, J. Andrassy, M. Guba, S. Richter, A. Kroemer, M. N. Scherer, M. Steinbauer, C. Graeb, H. J. Schlitt, K. W. Jauch, E. K. Geissler, Rapamycin protects allografts from rejection while simultaneously attacking tumors in immunosuppressed mice, Transplantation 77(9), 1319–1326 (2004).PubMedCrossRefGoogle Scholar
  32. 32.
    M. Guba, P. von Breitenbuch, M. Steinbauer, G. Koehl, S. Flegel, M. Hornung, C. J. Bruns, C. Zuelke, S. Farkas, M. Anthuber, K. W. Jauch, E. K. Geissler, Rapamycin inhibits primary and metastatic tumor growth by antiangiogenesis: involvement of vascular endothelial growth factor, Nat Med 8(2), 128–135 (2002).PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  • Stefan Schneeberger
    • 1
  • Marina Ninkovic
    • 2
  • Raimund Margreiter
    • 3
  1. 1.Division of Plastic SurgeryUniversity of PittsburghPittsburghPennsylvania
  2. 2.Department of Plastic and Reconstructive Surgery, Ludwig Boltzmann Institute for Quality ControlLeopold-Franzens UniversityInnsbruckAustria
  3. 3.Department for Transplantation SurgeryMedical University of InnsbruckInnsbruckAustria

Personalised recommendations