Hand Transplantation–Polish Program

Jabłecki, Jerzy; Kaczmarzyk, Leszek; Domanasiewicz, Adam; Chełmoński, Adam; Boratyńska, Maria; Patrzałek, D.

doi:10.1016/j.transproceed.2010.07.024

Cited by 9 publications

(12 citation statements)

References 5 publications

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“…HLA mismatches were 5, 5, 3, 5, and 4, respectively. All of the recipients experienced at least one skin rejection episode, treated with corticosteroids and topical tacrolimus . None of the recipients revealed histological signs of skin rejection at the time of evaluation (control biopsies showed Banff grade 0) or 12 months before and after examination.…”

Section: Methodsmentioning

confidence: 99%

Immune activation- and regulation-related patterns in stable hand transplant recipients

et al. 2016

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We assessed cell subsets and expression of a set of genes related to the T-cell populations in peripheral blood mononuclear cells to elucidate whether immune status of stable hand transplant recipients (HTx) differs from stable kidney transplant recipients (KTx). The study was conducted on five HTx 4.8 ± 1.7 years after transplantation and 30 stable KTx 7.9 ± 2.4 years after transplantation as well as 18 healthy volunteers. The research involved PBMC gene expression analysis of CD4, CD8, CTLA4, GZMB, FOXP3, IL10, IL4, ILR2A, NOTCH, PDCD1, PRF1, TGF-B, and TNF-A genes on a custom-designed low-density array (TaqMan) as well as flow cytometry assessment of lymphocyte subpopulations. HTx presented significantly increased expression of immunomodulatory genes (TNF, IL10, GITR, and PDCD1) compared to KTx and controls. HTx revealed a proinflammatory molecular pattern with higher expression of NOTCH and CD8 compared to KTx and controls. KTx showed a reduced level of regulatory T cells compared to controls and HTx. Both HTx and KTx presented an increased number of CD8 and CD8 CD28 T cells compared to controls. Stable hand transplant recipients exhibit persistent immune activation with rejection-related gene expression pattern counterbalanced by secondary induction of regulatory mechanisms.

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Section: Methodsmentioning

confidence: 99%

Immune activation- and regulation-related patterns in stable hand transplant recipients

et al. 2016

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“…Paired pre‐ and post‐transplantation DASH scores with a minimum follow‐up of 300 days were available for 10 patients, and they are shown in Table 1 [18–27]. The mean pretransplantation DASH score was 71.01 (±25.79), whereas the mean post‐transplantation DASH score was 43.39 (±26.48).…”

Section: Resultsmentioning

confidence: 99%

“…Malignancy was diagnosed in two patients: a surgically controlled basal cell carcinoma (BCC) and a case of medically controlled post‐transplant lymphoproliferative disease (PTLD) [45,46]. One graft was lost because of noncompliance with IS therapy [47], another because of vascular complications immediately after transplantation [23], and a third because of rejection [48]. One patient died 60 days after a combined face transplant and bilateral HAT [49].…”

Section: Resultsmentioning

confidence: 99%

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Landín

Bonastre

Díez

et al. 2012

Transplant International

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Summary The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts. Clinical cases of HAT published between 1999 and 2011 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Infectious, metabolic, and oncological complications because of IS therapy were recorded. Twenty‐eight patients were reported in 56 clinical manuscripts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (±19.04) points on the DASH score after HAT (P = 0.005). Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. The presence of intrinsic muscle function was observed in 57% of the recipients. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. Three grafts were lost to follow‐up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Fifty‐two complications caused by IS agents were reported, and they were successfully managed medically or surgically. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols.

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“…Next, the graft is revascularized by anastomosis of arteries and veins prior to repair of tendons and nerves and skin closure [8]. While most centers follow this algorithm, variations have been applied [28–30]. Cold ischemia time was kept below 13 h as the consequences of prolonged ischemia include muscle injury and fibrosis [29].…”

Section: Outcome After Hand Transplantationmentioning

confidence: 99%

“…For immunosuppression (IS) basiliximab, antithymocyte globulin (ATG) or alemtuzumab together with gradually reduced methylprednisolone was used in all cases. For maintenance, tacrolimus (serum concentrations between 6 and 15 ng/ml), mycophenolic acid (2 × 1 g) and steroids (5 mg/day) were applied and adjusted as per the individual protocol and requirements [8,27–32].…”

Section: Outcome After Hand Transplantationmentioning

confidence: 99%

Achievements and challenges in composite tissue allotransplantation

Schneeberger

Landín

Jableki³

et al. 2011

Transplant International

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Summary Overall, more than 60 hand/forearm/arm transplantations and 16 face transplantations have been performed in the past 12 years. In the European experience summarized here, three grafts have been lost in response to a vascular thrombosis (n = 1), rejection and incompliance with immunosuppression (n = 1) and death (n = 1). The overall functional and esthetic outcome is very satisfactory, but serious side effects and complications related to immunosuppression are challenges hindering progress in this field. The high levels of immunosuppression, skin rejection, nerve regeneration, donor legislation and the acceptance level need to be addressed to promote growth of this promising new field in transplantation and reconstructive surgery.

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Hand Transplantation–Polish Program

Cited by 9 publications

References 5 publications

Immune activation- and regulation-related patterns in stable hand transplant recipients

Immune activation- and regulation-related patterns in stable hand transplant recipients

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Achievements and challenges in composite tissue allotransplantation

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