[The first transplantation of a hand in humans. Early results].
The first hand allograft was performed on September 23, 1998. The right distal forearm and hand of a brain dead donor was transplanted to a 48 year old recipient who had undergone a traumatic amputation of the distal third of his right forearm. The donor's arm was irrigated with organ preservation solution (UW) and transported to Lyon in a cool container. Two teams simultaneously dissected the donor's limb and the recipient's stump to identify anatomical structures. Transplantation involved bone fixation, arterial and venous anastomoses, nerve sutures, joining of the muscles and tendons, and skin closure. Immunosuppression consisted of anti-lymphocyte, polyclonal and monoclonal antibodies, tacrolimus, mycophenolic acid, and prednisone. Mild clinical and histological signs of rejection occurred at week 9 after surgery. They disappeared with adjustments of the immunosuppressant doses. Seven months after surgery the patient was in good general condition. Intensive physiotherapy led to satisfactory progress of motor function. Sensory progress is excellent, reaching the fingertips. A longer follow-up is necessary to appreciate the final result. In the absence of further rejection, the functional prognosis of the graft should be similar to that reported after successful autoreconstruction.
Dubernard
J M
JM
Service de chirurgie de la transplantation et d'urologie, hôpital Edouard-Herriot, Lyon, France.
Owen
E
E
Herzberg
G
G
Martin
X
X
Guigal
V
V
Dawahra
M
M
Pasticier
G
G
Mongin-Long
D
D
Kopp
C
C
Ostapetz
A
A
Lanzetta
M
M
Kapila
H
H
Hakim
N
N
D000241:Adenosine / Q000627:therapeutic use; D000493:Allopurinol / Q000627:therapeutic use; D000673:Amputation, Traumatic / Q000601:surgery; D000714:Anastomosis, Surgical; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000601:surgery; D005978:Glutathione / Q000627:therapeutic use; D006084:Graft Rejection / Q000209:etiology; D006225:Hand / Q000098:blood supply / Q000294:innervation; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D009173:Mycophenolic Acid / Q000627:therapeutic use; D019188:Organ Preservation Solutions / Q000627:therapeutic use; D026741:Physical Therapy Modalities; D011241:Prednisone / Q000627:therapeutic use; D011887:Raffinose / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013710:Tendons / Q000601:surgery; D014184:Transplantation, Homologous
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D009173:Mycophenolic Acid; D000241:Adenosine; D011887:Raffinose; D011241:Prednisone; D016559:Tacrolimus