LONG-TERM RESULTS OF TWO CASES OF BILATERAL HAND TRANSPLANTATION: LYON EXPERIENCE

Abstract

O130 Aims: To report our experience about bilateral hand allotransplantation. Methods: The first bilateral hand transplantation was performed in January 2000 and the second case on April 30, 2003. The first recipient was a 33-year old man with bilateral amputation at midforearm level from four years and the second recipient was a 22-year old man with amputation at proximal forearm level on the right side and at wrist level on the left side from two years. The immunosuppressive protocol included tacrolimus, mycophenolate mofetil, prednisone and, for induction, antithymocyte globulins. An intensive rehabilitation program started 12 hours after surgery and included physiotherapy, electrostimulation and occupational therapy. Results: An arterial thrombosis, which was quickly reversed, occurred at day 1 post-transplantation in the second recipient. Side-effects included transient hyperglycemia during the first month post-transplantation in the first recipient and an ostheomyelitis at day 152 in the second patient with complete resolution after 6 months of antibiotics. During the follow-up period no malignancies occurred and no signs of graft-versus-host disease were shown in either patient. Only two episodes of acute skin rejection (asymptomatic maculopapular lesions) occurred on days 52 and 82 and on days 55 and 86 in the first and in the second recipient respectively. In all cases the episodes resolved by increasing oral steroid dose within 10-15 days. Nerve regeneration has been demonstrated by histological studies, electromyography and sensitive tests as well as cortical reorganization by functional magnetic resonance imaging in both patients. In the first bilateral hand transplantation there is a normal sensitivity to pain and thermal stimuli and a good sensitivity to dynamic and static pressure with some errors in discrimination of the localisation. Intrinsic musculature recovery started at 9 months and at present he can dissociate each single finger movement. His grip and pinch strength is 3 Kg and 1.5 Kg respectively. The patient is able to perform the same daily activities that were possible with the myoelectric prostheses before the transplantation. In addition, several activities such as holding a pen or a glass or a pair of scissors, shaving, taking care of his personal hygiene that were impossible before are at present easily performed by the patient. In the second bilateral hand transplantation there is a normal sensitivity to pain and thermal stimuli, a discrete tactile sensation and a discriminative sensation ranging between 8 and 15 mm. Intrinsic musculature recovery started at 6 months on the left side and at 9 months on the right side. His grip strength is 8 kg on the right and 10 Kg on the left side while his pinch strength is more than 1 kg on both sides. He is already able to take care of his personal hygiene and to hold several objects, such as a glass. Conclusions: Although these results are very encouraging, other cases are required.