The first right hand and the first bilateral hand transplantation were performed in Lyon (France) on September 23, 1998 and on January 13, 2000, respectively; then a second bilateral hand transplantation was performed on April 30, 2003. These cases of hand transplantation demonstrated that it was possible to perform composite tissue allografts.
The immunosuppressive protocol used for all French patients included an induction therapy (antithymocyte globulins, prednisone, tacrolimus, and mycophenolate mofetil) and a maintenance therapy (prednisone 5 mg/d, tacrolimus with blood levels between 5 and 10 ng/ml, and mycophenolate mofetil 2 g/d).
The results achieved in the first case of hand allotransplantation showed the feasibility of the surgical technique, the efficacy of the immunosuppressive protocol, the limited adverse effects, and the importance of patient’s compliance and rehabilitation to ensure graft viability and functional recovery. The recipient of the first single hand transplantation, a 48-year-old-man from New Zealand, whose right arm was accidentally amputated in 1984, received the hand from a 41-year-old brain-dead man. They presented the same blood group and several HLA mismatches, negative T- and B-cell cross-match. During the first months the patient presented a well-vascularized hand graft with normal skin and fast nerve regeneration which resulted in protective and useful sensation. He was able to perform the majority of daily activities (such as gripping a glass or writing) with his grafted right hand. At this time he presented a transient hyperglycemia and a Herpes virus infection as side effects of his immunosuppressive treatment, and 8 weeks after transplantation an acute rejection episode characterized by erythematous maculopapular lesions disseminated on the transplanted hand, which regressed increasing the oral dose of steroids and using topical immunosuppressants, such as tacrolimus and clobetasol creams.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
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, 1315–1320 (1999).
J. M. Dubernard, P. Petruzzo, M. Lanzetta, H. Parmentier, X. Martin, M. Dawahra, et al., Functional results of the first human double-hand transplantation, Ann Surg 238(1), 128–136 (2003).
P. Petruzzo, L. Badet, A. Gazarian, M. Lanzetta, H. Parmentier, J. Kanitakis, A. Sirigu, X. Martin, J. M. Dubernard, Bilateral hand transplantation: six years after the first case, Am J Transpl 6, 1–7 (2006).
J. M. Dubernard, E. Owen, N. Lefrancois, P. Petruzzo, X. Martin, M. Dawahra, D. Jullien, J. Kanitakis, C. Frances, X. Preville, L. Gebuhrer, N. Hakim, M. Lanzetta, H. Kapila, G. Herzberg, J. P. Revillard, First human hand transplantation: case report, Transpl Int 13(Suppl 1), S521–524 (2000).
J. Kanitakis, D. Jullien, P. Petruzzo, N. Hakim, A. Claudy, J. P. Revillard, E. Owen, J. M. Dubernard, Clinicopathologic features of graft rejection of the first human hand allograft, Transplantation 27(4), 688–693 (2003).
J. Kanitakis, P. Petruzzo, D. Jullien, L. Badet, M. C. Dezza, A. Claudy, M. Lanzetta, N. Hakim, E. Owen, J. M. Dubernard, Pathological score for the evaluation of allograft rejection in human hand (composite tissue) allotransplantation, Eur J Dermatol 15(4), 235–238 (2005).
P. Petruzzo, J. P. Revillard, J. Kanitakis, M. Lanzetta, N. Hakim, N. Lefrançois, et al., First human double hand transplantation: efficacy of a conventional immunosuppressive protocol, Clin Transplant 17(5), 455–460 (2003).
P. Giraux, A. Sirigu, F. Schneider, J. M. Dubernard, Functional cortical reorganization after transplantation of both hands as revealed by fMRI. Nat Neurosci 4, 691–692 (2001).
P. Giraux, A. Cheylus, J. R. Duhamel, P. Petruzzo, J. M. Dubernard, A. Sirigu, Motor recovery after bilateral hand transplantation: a two year follow-up study [abstract]. Transplantation 74(4), 63 (2002).
Z.-W. Chen, V. E. Meyer, H. E. Kleinert, R. W. Beasley, Present indications and contraindications for replantation as reflected by l ong-term functional results, Orthop Clin North Am 12, 849–870 (1981).
T. Ipsen, L. Lundkvist, T. Barfred, J. Pless, Principles of evaluation and results in microsurgical treatment of major limb amputations: a follow-up study of 26 consecutive cases 1978–1987, Scand J Plast Reconstr Hand Surg 24, 775–780 (1990).
D. C. Beaton, J. N. Katz, A. H. Fossel, J. G. Wright, V. Tarasuk, C. Bombardier, Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the extremity, J Hand Ther 14, 128–146 (2001).
M. Lanzetta, P. Petruzzo, R. Margreiter, J. M. Dubernard, F. Schuind, W. Breidenbach, et al. The International Registry on Hand and Composite Tissue Transplantation 15;79(9):1210–1214 (2005).
M. Lanzetta, P. Petruzzo, J. M. Dubernard, R. Margreiter, W. Breidenbach, et al. Second report (1998–2006) of the International Registry of Hand and Composite Tissue Transplantation. Transpl Immunol Jul; 18(1):1–6 (2007).
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2008 Springer
About this chapter
Cite this chapter
Petruzzo, P. et al. (2008). Hand Transplantation: Lyon Experience. In: Hewitt, C.W., Lee, W.P.A., Gordon, C.R. (eds) Transplantation of Composite Tissue Allografts. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-74682-1_15
Download citation
DOI: https://doi.org/10.1007/978-0-387-74682-1_15
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-74681-4
Online ISBN: 978-0-387-74682-1
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)