Long‐term outcome after hand and forearm transplantation – a retrospective study. (10th November 2020)

• Record Type: Journal Article
• Authors: Hautz, Theresa; Messner, Franka; Weissenbacher, Annemarie; Hackl, Hubert; Kumnig, Martin; Ninkovic, Marina; Berchtold, Valeria; Krapf, Johanna; Zelger, Bettina G.; Zelger, Bernhard; Wolfram, Dolores; Pierer, Gerhard; Löscher, Wolfgang N.; Zimmermann, Robert; Gabl, Markus; Arora, Rohit; Brandacher, Gerald; Margreiter, Raimund; Öfner, Dietmar; Schneeberger, Stefan
• Is Part Of: Transplant international. Volume 33:Number 12(2020)
• Page Start: 1762
• Page End: 1778
• Publication Date: 2020-11-10
• Subjects: complications -- donor‐specific antibodies -- hand and forearm transplantation -- immunosuppression -- rejection -- vascularized composite allotransplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13752
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Between 2000 and 2014, five patients received bilateral hand ( n = 3), bilateral forearm ( n = 1), and unilateral hand ( n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long‐term results at 20 years. During the 6–20 years follow‐up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody‐related with serum donor‐specific alloantibodies (DSA) and skin‐infiltrating B‐cells. The cell phenotype in rejecting skin biopsies changed and C4d‐staining increased with time post‐transplantation. In the long‐term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well‐being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection‐free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA.