International Registry On Hand and Composite Tissue Transplantation.

Abstract

The IRHCTT includes hand and face allotransplantations. Methods: Since September 1998 66 upper extremity transplantations (22 unilateral and 22 bilateral transplants) have been reported, for a total of 44 patients. They were 35 males and 9 females, median age 32.5 years. In the majority of cases the level of amputation was distal, but there were also 6 arm transplantations. Since November 2005 20 cases of partial or complete face transplantations have been reported, 15 males and 5 females, median age 46 years. In the majority of cases the deficit included cheek, nose, chin, lips and perioral area. The patients presented impairment or impossibility of swallowing, eating, drinking and speaking. In hand and face transplantation the imunosuppressive therapy included tacrolimus, mycophenolate mofetil, sirolimus and steroids; polyclonal or monoclonal antibodies were used for induction. Follow-up ranges from 8 months to 15 years for upper extremity transplantation and from 6 months to 8 years for face transplantation. Results: One simultaneous face and bilateral hand transplantation died on day 65, one bilateral arm transplantation for congestive heart failure on day 1 and one bilateral hand transplantation for sepsis on day 101. Another case of face transplantation died for pharyngo-laryngeal neoplasia three years after transplantation. Six patients transplanted have lost their grafted hands during the follow-up. 75% percent of hand recipients and 50% of face recipients experienced at least one episode of acute rejection within the first post-transplant year that was reversible when promptly treated. The first cases of chronic rejection were reported and the cause was often the patients’ non-compliance. Complications included, as in solid organ transplantation, opportunistic infections, metabolic complications and malignancies. Hand-grafted patients developed protective sensibility, 90% of them tactile sensibility and 80% also a partial discriminative sensibility Motor recovery enabled patients to perform most daily activities. Face-grafted patients improved their aesthetic aspect and they were able to perform some activities such as eating, drinking and speaking, living a normal social life. Conclusions: Hand and face transplantations are successful procedures, however careful evaluation of patients before and after transplantation and their compliance are indispensable.