5-Year Activity and Participation Outcomes of the First Successful Pediatric Bilateral Hand Transplantation: A Case Report

Levy, Todd J.; Tyner, Callie E.; Amaral, Sandra; Lefkowitz, Debra S.; Kessler, Sudha Kilaru; Levin, L. Scott

doi:10.1080/01942638.2022.2057210

Cited by 3 publications

(8 citation statements)

References 45 publications

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“…The field of HT is exceptionally dynamic and scientific advancement will inevitably drive changes in eligibility criteria, one past example is the age of eligibility. Historically, most centers placed strict age Akdeniz University Hospital 15,16 Antalya, Turkey 2021 Amrita Institute of Medical Sciences 17,18 Kochi, India 2017 Boston Children's Hospital 19 Boston, MA 2022 Brigham and Women's Hospital [20][21][22][23][24][25][26][27] Boston, United States 2011-2022 Chang Gung Memorial Hospital [28][29][30][31] Children's Hospital of Philadelphia 5,[32][33][34][35][36] Taipei, Taiwan Philadelphia, PA 2016-2020 2016-2022 Clinica Cavadas [37][38][39][40][41] Valencia, Spain 2009, 2011 Duke University [42][43][44][45][46][47][48][49] Durham, USA 2011, 2018, 2021, 2022 Emory University 50,51 Atlanta, United States 2015 Hacettepe University 52 Ankara, Turkey 2014 Harbin Medical University 53 Harbin, China 2016 Hôpital Edouard Herriot 9,[54][55]…”

Section: Discussionmentioning

confidence: 99%

“…139 While currently there are only two centers that accept pediatric candidates, this milestone in reconstructive surgery may incentivize other VCA centers to expand criteria to include a pediatric population. 5,19…”

Section: Discussionmentioning

confidence: 99%

“…Only 2 programs included pediatric patients (6.1%). 5,19 Notably, these 2 programs changed their criteria from pediatric-exclusionary to inclusionary. From those that operated only on adult populations, 12 centers established a maximum age of 60 years.…”

Section: Demographic and Psychosocial Considerationsmentioning

confidence: 99%

“…1,2 First successfully performed in 1998, there are to date approximately 148 individuals that have undergone hand or distal upper extremity transplants, including one pediatric transplant and one combined face and double-hand transplant. [3][4][5] There are approximately 2.1 million individuals in the United States who live with upper limb loss. 6 Of the therapeutic options available that re-establish fine motor control for those with limb defects, HT is an attractive option because of its ability to successfully restore upper extremity form and function.…”

mentioning

confidence: 99%

“…Hand transplantation (HT) has emerged as a treatment of last resort for those who endured amputation or irreparable loss of upper extremity function 1,2 . First successfully performed in 1998, there are to date approximately 148 individuals that have undergone hand or distal upper extremity transplants, including one pediatric transplant and one combined face and double-hand transplant 3–5 . There are approximately 2.1 million individuals in the United States who live with upper limb loss 6 .…”

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confidence: 99%

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Vascularized Composite Allotransplantation of the Hand

et al. 2023

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Background Hand transplantation (HT) has emerged as an intervention of last resort for those who endured amputation or irreparable loss of upper extremity function. However, because of the considerable effort required for allograft management and the risks of lifelong immunosuppression, patient eligibility is critical to treatment success. Thus, the objective of this article is to investigate the reported eligibility criteria of HT centers globally. Methods A systematic review of the HT literature was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, using PubMed, Cochrane, Ovid/Medline, and Scopus. Program Web sites and clinicaltrials.gov entries were included where available. Results A total of 354 articles were reviewed, 101 of which met inclusion criteria. Furthermore, 10 patient-facing Web sites and 11 clinical trials were included. The most reported criteria related to the capacity to manage the allograft posttransplantation, including access to follow-up, insurance coverage, psychological stability, and history of medical compliance. Other factors related to the impact of immunosuppression, such as active pregnancy and patient immune status, were less emphasized. Conclusions Because of the novelty of the field, eligibility criteria continue to evolve. While there is consensus on certain eligibility factors, other criteria diverge between programs, and very few factors were considered absolute contraindications. As the popularity of the field continues to grow, we encourage the development of consensus evidence-based eligibility criteria.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Demographic and Psychosocial Considerationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Vascularized Composite Allotransplantation of the Hand

et al. 2023

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Somatosensory and motor representations following bilateral transplants of the hands: A 6-year longitudinal case report on the first pediatric bilateral hand transplant patient

Gaetz¹,

Dockstader²,

Furlong³

et al. 2023

Brain Research

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Immunosuppressive strategies in face and hand transplantation: a comprehensive systematic review of current therapy regimens and outcomes

Huelsboemer,

Boroumand,

Kochen

et al. 2024

Front. Transplant.

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BackgroundRecipients of Vascularized Composite Allotransplants require effective immunosuppressive therapy to prevent graft rejection. This systematic review summarizes the current body of literature on immunosuppressive regimens used in face and hand transplants while summarizing their outcome in terms of rejection, renal failure, and infections.MethodsA systematic search of electronic databases was conducted to identify relevant studies from 1998 until July 1st, 2023. We included all studies that discussed immunosuppressive strategies in face and hand transplant recipients according to PRISMA.ResultsThe standard triple maintenance therapy was mostly adjusted due to nephrotoxicity or high incidence of rejection. The most common alternative treatments utilized were sirolimus (25/91; 27.5%) or everolimus (9/91; 9.9%) following hand- and photophoresis (7/45; 15.6%), sirolimus (5/45; 11.1%) or belatacept (1/45; 2.2%) following face transplantation. Episodes of rejection were reported in 60 (65.9%) of hand- and 33 (73%) of face transplant patients respectively. Graft loss of 12 (13.2%) hand and 4 (8.9%) face transplants was reported. Clinical CMV infection was observed in 6 (6.6%) hand and 7 (15.5%) face transplant recipients.ConclusionsBased on the herein presented data, facial grafts exhibited a heightened incidence of rejection episodes and CMV infections. Facial mucosa adds complexity to the immunological graft composition highlighting the need of individualized immunosuppressive regimens and further research.

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5-Year Activity and Participation Outcomes of the First Successful Pediatric Bilateral Hand Transplantation: A Case Report

Cited by 3 publications

References 45 publications

Vascularized Composite Allotransplantation of the Hand

Vascularized Composite Allotransplantation of the Hand

Somatosensory and motor representations following bilateral transplants of the hands: A 6-year longitudinal case report on the first pediatric bilateral hand transplant patient

Immunosuppressive strategies in face and hand transplantation: a comprehensive systematic review of current therapy regimens and outcomes

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