VCA at Innsbruck Medical University - An Update 14 Years After the First Hand Transplantation.

Abstract

Background We describe here the outcome after two bilateral hand, one bilateral forearm and one unilateral hand transplantation at 14, 11, 8 and 5 years after transplantation. Patients Since March 2000, four patients received a bilateral hand, a bilateral forearm or a unilateral hand transplantation at Innsbruck Medical University. All patients received induction therapy. Antithymocyte globulin or alemtuzumab was followed by tacrolimus, prednisolon, MMF or tacrolimus and MMF maintenance immunosuppression (IS). Later, sirolimus/everolimus was added under simultaneous withdrawal or dose reduction of tacrolimus or MMF. Steroids were avoided in one and withdrawn in two patients. Results Hand function correlated well with time after transplant and amputation level. Intrinsic hand muscle function recovery and discriminative sensation were observed in all patients. Complications included CMV infection, fungal infection, hypertension, hyperglycemia, transient creatinine increase and headache and a bullous pemphigoid. Three, six, four, and two rejection episodes, thereof two DSA+ antibody-mediated rejections, were successfully treated with steroids, anti-CD25, anti-CD52 and anti-CD20 antibodies and/or intensified maintenance IS. Skin histology at current shows no or mild perivascular lymphocytic infiltrates without signs of progression. Radiomorphological studies do not show any signs for luminal narrowing of vessels. Conclusion The overall functional outcome and patient satisfaction after bilateral hand, bilateral forearm and unilateral hand transplantation are highly encouraging. All patients are now free of rejection with moderate levels of IS.