Hand transplantation: Comparisons and observations of the first four clinical cases

Abstract

Twenty, 15, and 8 months after the first four successful human hand transplant procedures were performed in Lyon (France), Louisville (U.S.), and Guangzhou (China), the transplant teams convened in Louisville, Kentucky, to share their experiences at the Second International Symposium on Composite Tissue Allotransplantation. This article presents reconstructive and immunological data from these landmark procedures in tabular format, in an attempt to answer some key questions about early outcomes of clinical hand transplantation. On the basis of these data, the initial outcomes of the first four hand transplants are encouraging and warrant proceeding with additional hand transplantations.

Hand transplantation

“…The motor function of the first 4 hand transplants (Francois et al 2000) was evaluated by Carroll (1965), using a test which assesses integrated upper extremity and global hand function on a scale from 0-99 points. Outcome is considered to be poor if the test result is less than 50 points, fair if it is between 51 and 74 points, good if it is between 75 and 84 points, and excellent if it is above 85 points.…”

“…Although critics have argued that the long-term functional outcomes of hand transplantation are unknown , initial results suggest a high degree of patient satisfaction with minimal morbidity and no mortality (Francois et al 2000, Owen et al 2001, Petit et al 2003. The two exceptions to this encouraging record have been the first French patient (Petruzzo and Dubernard 2001) and the first Chinese patient (Guoxian et al 2004).…”

“…In the first 4 hand transplant patients (Francois et al 2000), the following complications were observed during the first 8-20 months postoperatively: insulin-dependent diabetes mellitus (Lyon), Cushing's syndrome (Guangzhou 1), cytomegalovirus colitis (Louisville), herpetic cutaneous infection (Lyon), and recurrent cutaneous mycosis (Louisville, Guangzhou 1). All of these complications were treated successfully with dose reduction of the immunosuppressants, insulin therapy, temporary intravenous and long-term oral ganciclovir, and topical treatment.…”

Facial Transplantation

“…Since the first hand transplant in France in 1998, 35 hand allograft transplants have been performed worldwide. [16][17][18][19][20] More than 50 other CTA transplants have been performed worldwide; they include 9 abdominal wall transplants, 8 knees, 7 nerve allografts, 2 flexor tendon apparatus, 1 larynx, 1 skeletal muscle, 1 tongue, 1 penis, and 2 partial face transplants. transplantation has gained much public attention.…”

Hand transplantation: current challenges and future prospects

“…[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.…”