2527: The International Registry on Hand and Composite Tissue Allotransplantation (IRHCTT)

Petruzzo, Palmina; Dubernard, Jean Michel; Lanzettà, Marco

doi:10.1080/23723505.2016.1232944

Cited by 67 publications

(108 citation statements)

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“…The registry has collected prospective data on transplant patients since 2002. 7 The last report, 6 published in 2011, includes 39 patients who underwent 57 hand transplants. With regard to immunosuppressive complications, a majority (90%) of patients had metabolic complications (hyperglycemia, end-stage renal disease, Cushing syndrome, hyperparathyroidism), and 77% of patients suffered from opportunistic infections at some point during follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9][10][11][12][13][14][15][16][17] Though it offers sensation, function, cosmetic, and psychological benefits, there are significant risks associated with the lifelong immunosuppressive medication required with transplantation. 4,5,7,12,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] This article aims to outline the challenges of hand transplantation by discussing patient selection, effect on quality of life, financial burden, functional outcomes, and risks of immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

“…69 Data from the IRHCTT show that 85% of hand transplant recipients experience one or more episodes of acute rejection. 6 The clinical presentation includes erythematous maculopapular rash, hair loss, and desquamation. Close monitoring of skin changes is important to ensure there are no early signs of rejection.…”

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confidence: 99%

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Hand transplantation: current challenges and future prospects

Alolabi¹,

Augustine²,

Thoma³

2017

TRRM

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Over the last two decades, 113 vascularized composite allotransplantation (VCA) of the hand have been performed in 76 patients globally. The procedure that was once regarded as experimental has certainly emerged as a clinical reality with multiple centers worldwide now performing it. The psychological and physical impact of losing an upper extremity is profound. Amputees face significant challenges contributing to disability and dependence even with activities of daily living. Hand transplantation offers functions with restoring sensation, voluntary motor control, and proprioception, as well as a sense of feeling "whole" again. Along with these benefits, however, transplantation carries a significant risk profile attributed to the complications of life-long immunosuppression and possible rejection. Moreover, the procedure carries a significant financial burden to the health care system. As hand VCA is becoming more widely accepted and performed worldwide, there are still many challenges that will face its rapid growth. This review highlights some of the challenges facing hand VCA including patient selection, effect on quality of life, financial burden, functional outcomes, and complications of immunosuppression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hand transplantation: current challenges and future prospects

Alolabi¹,

Augustine²,

Thoma³

2017

TRRM

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“…As such, over 100 hand/forearm and face transplants have been performed worldwide with highly encouraging functional, immunological, and esthetic results over the past decade (Petruzzo and Dubernard 2011;Sarhane et al 2012). However, the unique requirement for nerve regeneration over long distances to regain full motor and sensory function of such transplants still significantly hampers expansion of the indications for VCA to arm or lower extremity transplantation, and therefore, its full utilization as a reconstructive modality for devastating limb loss.…”

Section: Introductionmentioning

confidence: 99%

Stem Cell-Based Approaches to Improve Nerve Regeneration: Potential Implications for Reconstructive Transplantation?

Khalifian

Sarhane

Tammia

et al. 2014

Arch. Immunol. Ther. Exp.

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Reconstructive transplantation has become a viable option to restore form and function after devastating tissue loss. Functional recovery is a key determinant of overall success and critically depends on the quality and pace of nerve regeneration. Several molecular and cell-based therapies have been postulated and tested in pre-clinical animal models to enhance nerve regeneration. Schwann cells remain the mainstay of research focus providing neurotrophic support and signaling cues for regenerating axons. Alternative cell sources such as mesenchymal stem cells and adipose-derived stromal cells have also been tested in pre-clinical animal models and in clinical trials due to their relative ease of harvest, rapid expansion in vitro, minimal immunogenicity, and capacity to integrate and survive within host tissues, thereby overcoming many of the challenges faced by culturing of human Schwann cells and nerve allografting. Induced pluripotent stem cell-derived Schwann cells are of particular interest since they can provide abundant, patient-specific autologous Schwann cells. The majority of experimental evidence on cell-based therapies, however, has been generated using stem cell-seeded nerve guides that were developed to enhance nerve regeneration across "gaps" in neural repair. Although primary end-to-end repair is the preferred method of neurorrhaphy in reconstructive transplantation, mechanistic studies elucidating the principles of cell-based therapies from nerve guidance conduits will form the foundation of further research employing stem cells in end-to-end repair of donor and recipient nerves. This review presents key components of nerve regeneration in reconstructive transplantation and highlights the pre-clinical studies that utilize stem cells to enhance nerve regeneration.

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“…Despite potent systemic immunosuppression, approximately 85% of all patients experience at least one episode of acute skin rejection in the first year after transplantation, and as many as 56% experience multiple episodes (6). Currently, diagnosis of rejection in skin-containing VCAs is confirmed by histological analyses of allograft skin biopsies according to the 2007 Banff classification (7), which is based on the location and intensity of inflammatory infiltrates.…”

Section: Introductionmentioning

confidence: 99%