Outcomes After Bilateral Hand Allotransplantation: A Risk/Benefit Ratio Analysis. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Petruzzo, Palmina; Gazarian, Aram; Kanitakis, Jean; Parmentier, Helene; Guigal, Vincent; Guillot, Michel; Vial, Christophe; Dubernard, Jean Michel; Morelon, Emmanuel; Badet, Lionel
• Is Part Of: Annals of surgery. Volume 261:Issue 1(2015:Jan.)
• Publication Date: 2015-01
• Subjects: bilateral hand allotransplantation -- complications -- functional recovery -- outcomes -- patient and graft survival; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000627
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Background: The clinic era of composite tissue allotransplantation was inaugurated by hand allotransplantation in 1998, giving rise to many controversies and scepticism because of the lifelong immunosuppression, the unclear risk-benefit ratio, and the uncertain long-term functional results of the procedure. The aim of this study was to evaluate the outcomes and the risk/benefit balance in bilateral hand allotransplantation. Methods: The study included 5 cases of bilateral hand allotransplantation performed in a single center, with a follow-up ranging from 3 to 13 years. The recipients (4 men, 1 woman) were young. The level of amputation was distal in all cases except for 2 patients amputated at the midforearm level. All the recipients initially received the same immunosuppressive treatment that included tacrolimus, mycophenolate mofetil, prednisone, and, for induction, antithymocyte globulins. Results: Patient and graft survival was 100%. All recipients showed adequate sensorimotor recovery (protective and tactile sensitivity and partial recovery of intrinsic muscles), they were able to perform the majority of activities of daily living, and had a normal social life. Most complications occurred in the first posttransplant year and were successfully managed. All recipients experienced at least 1 episode of acute rejection, which was easily reversed by increasing oral steroid dose or by intravenous steroids, except for patient 3, who presented 6 episodes of acute rejection, the latest 2 treated with Campath-1H. Conclusions: Although bilateral hand transplantation may be a satisfactory treatment option for amputees, a careful selection of candidates and a rigorous evaluation of recipients after transplantation are imperative. Abstract : This study evaluates the outcomes and the risk/benefit balance in 5 cases of bilateral hand allotransplantation (follow-up 3-13 years). Sensorimotor recovery allowed the recipients to perform the majority of daily activities living a normal social life. Up to now, the acute rejection episodes and the complications could be successfully treated.