NDLI: Outcomes of the first 2 American hand transplants at 8 and 6 years posttransplant.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Breidenbach, Warren C. Gonzales, N. Ruben Kaufman, Christina L. Klapheke, Martin Tobin, Gordon R. Gorantla, Vijay S.
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Breidenbach WC ( Christine M. Kleinert Institute of Hand and Microsurgery, Jewish Hospital, Louisville, KY, USA. WBreidenbach@kleinertkutz.com)
Abstract	PURPOSE: The feasibility of hand allotransplantation has been demonstrated. The purpose of the article is to report the (1) functional return, (2) psychosocial outcomes, (3) clinical and histological assessment for rejection, (4) complications, and (5) graft survival in the 2 American hand transplant recipients. METHODS: We present 2 patients 106 and 81 months, respectively, after unilateral transplantation of an allogeneic hand and forearm. We analyzed clinical course, number of rejection episodes, adverse events, function of the allograft, and quality of life. Clinical laboratory results, biopsy histology, and patient clinical examinations were used to compare the clinical course. Standard hand function tests were used to evaluate function. Psychological interviews were used to assess acceptance and quality of life. RESULTS: Our patients have allograft survival with improvements in intrinsic muscle activity, total active motion and return of functional grip, pinch strength, and sensibility. Rejection episodes were restricted primarily to the first 6 months after transplantation, and all responded to treatment. The major posttransplantation complications were a cytomegalovirus infection in patient 1 and osteonecrosis of the hip requiring both hips to be replaced, 1 at year 4 and the other at year 6, as well as transient immunosuppression-related diabetes in patient 2. Recently we have weaned both patients off maintenance steroids. Current Carroll scores are fair for patient 1 (72/99) and fair for patient 2 (55/99), although patient 2 has not had good recovery of intrinsic function. Both patients are back at work and report an excellent quality of life at nearly 9 and 7 years, respectively, after transplantation. CONCLUSIONS: Our intermediate long-term results of hand transplants have demonstrated functional return similar to that of replants. Graft survival and quality of life after hand transplantation has far exceeded initial expectations. We conclude that allogeneic hand transplant is feasible and holds promise as a treatment modality for catastrophic upper extremity loss. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
File Format	HTM / HTML
ISSN	03635023
Issue Number	7
Volume Number	33
e-ISSN	15316564
Journal	The Journal of Hand Surgery
Language	English
Publisher	Elsevier
Publisher Date	2008-09-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Surgery Hand Injuries Surgery Hand Transplantation Organ Transplantation Adult Graft Rejection Drug Therapy Graft Survival Humans Male Psychology Rehabilitation Recovery Of Function Treatment Outcome United States Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Orthopedics and Sports Medicine Surgery

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