THE INTERNATIONAL REGISTRY ON HAND AND COMPOSITE TISSUE ALLOGRAFT

Abstract

O132 Aims: Since May 2002 all groups performing hand transplantations have supplied detailed information to the International Registry on Hand and Composite Tissue Transplantation. This inaugural report provides a comprehensive review of all hand transplants performed to date. Methods: From September 1998 to March 2004 nineteen male patients underwent 25 hand/forearm/digit transplantations (12 monolateral and 4 bilateral hand transplantations, 2 bilateral forearm transplantations, 1 thumb transplantation). Recipients were all males aged between 19 and 52 (average 32 years). Time since amputation ranged from two months to 22 years (mean 5.4 yrs). Immunosuppressive therapy included tacrolimus, mycophenolate mofetil, rapamycin and steroids; polyclonal or monoclonal antibodies were used for induction. Topical immunosuppression was administered in some patients. Results: Acute rejection episodes occurred in 75 % of the patients. In most cases treatment of the first rejection episode included high-dose intravenous steroids; in cases where no steroids were administered intravenously, oral steroid treatment was increased. Tacrolimus, corticosteroid or flumix ointment (alone or in combination between them) was applied in all cases of rejection. Treatment of a second, third or fourth rejection episode varied considerably, but it was completely reversible in all compliant patients. In one case, following the patient’s non-compliance with immunosuppressive therapy, cutaneous lichenoid-like lesions occurred. Side-effects included opportunistic infections, such as CMV infections, and metabolic complications, such as transient hyperglycemia, and increase in creatinine values. No life-threatening complications or malignancies were reported. All transplants were technically successful, and only minor surgical complications were observed. There was one case of early perioperative arterial thrombosis which was quickly reversed. Patient as well as graft survival was 100 % at 2 years. Two cases of graft failure at a later date were caused by severe inflammation and progressive rejection in a non-compliant patient Nerve regeneration was particularly good in all patients, showing a satisfactory degree of protective sensation recovery (i.e. the ability to detect pain, thermal stimuli and gross tactile sensation). A certain degree of discriminative sensation was also reported, although this was not to the same degree at all parts of the graft. At two years post-transplantation 12 hands showed different degrees of discriminative sensation recovery. Motor recovery began with extrinsic muscle function, allowing the patients to perform grasp and pinch activities. Function of intrinsic muscles was only observed at a later stage, starting at 12 months post-transplantation in the majority of patients. Patients showed the ability to perform the majority of daily activities. Conclusions: Despite the enormous antigen load associated with CTA, hand transplantation became a clinical reality with immunosuppression comparable to transplantation of solid organs.