Four-Year Follow-Up of the World’s First Pediatric Bilateral Hand-Forearm Transplants: Do They Grow as Expected?

Abstract

Background: In 2015, the first bilateral pediatric hand-forearm transplant was performed in an 8-year-old boy. The growth rate of the transplanted upper extremities was unknown at the time. Methods: Forearm and hand radiographs were obtained annually. Radius and ulna measurements were performed by multiple coauthors and mathematically normalized using a standardized methodology. The Greulich and Pyle atlas was used to estimate hand bone age. Results: From July of 2015 to July of 2019, unadjusted bone length (metaphysis to metaphysis) increased 38.8 and 39.6 mm for the left radius and ulna, and 39.5 and 35.8 mm for the right radius and ulna, respectively. Distal physes of the donor limbs increasingly contributed to overall bone length relative to proximal physes. Normalized growth between the two limbs was statistically similar. At each annual follow-up, the bone age increased by 1 year. Conclusions: Successful pediatric hand-forearm transplantation offers the advantage of growth similar to that of nontransplanted pediatric patients. The transplanted distal physes contributes more to the overall growth, paralleling normal pediatric growth patterns. Chronologic age parallels the increase in bone age. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

From replantation to transplantation: The evolution of orthoplastic extremity reconstruction

“…The functional outcomes at 18 months of this pediatric heterologous bilateral hand and forearm transplant have been reported 84 . The growth has been as expected in this pediatric transplant 85 …”

“…84 The growth has been as expected in this pediatric transplant. 85 13 | LOOKING AT THE FUTURE OF VCA…”

Special Considerations in Face Transplantation: A Systematic Review

“…Although a pediatric facial transplant has not yet occurred, a bilateral hand transplant was successfully performed in an 8-year old boy with strong 4-year follow-up. 32,33 Vascularized composite allotransplantation of the face is likely more nuanced, but given the significant progress, it is a very likely future endeavor.…”

What is needed to ensure long-term sustainability for the field of vascularized composite allotransplantation?

“…The oldest hand transplant recipient – performed in Louisville, Kentucky in 1999 – has had over 20 years of hand function. The first bilateral pediatric hand transplant recipient performed in 2015 rock climbs and plays the cello [4]. His transplanted arms have demonstrated age appropriate growth and his brain has undergone somatotopic map reorganization [4–7].…”

“…The first bilateral pediatric hand transplant recipient performed in 2015 rock climbs and plays the cello [4]. His transplanted arms have demonstrated age appropriate growth and his brain has undergone somatotopic map reorganization [4–7].…”