Transplantation of Composite Tissue Allografts

pp 234-250

Hand Transplantation: The Innsbruck Experience

  • Stefan SchneebergerAffiliated withDivision of Plastic Surgery, University of Pittsburgh
  • , Marina NinkovicAffiliated withDepartment of Plastic and Reconstructive Surgery, Ludwig Boltzmann Institute for Quality Control, Leopold-Franzens University
  • , Raimund MargreiterAffiliated withDepartment for Transplantation Surgery, Medical University of Innsbruck

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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.