[First transplantation of two hands: results after 18 months].
OBJECTIVE
The previous results achieved in single hand transplantations confirmed the feasibility of this procedure and encouraged us to perform the first human double hand transplantation, which was performed in January 2000. In the present study we reported the results obtained eighteen months after transplantation.


METHODS
The recipient was a 33-year old man suffering from a traumatic amputation of both hands in 1996. Surgery included procurement of the upper extremities from a 18-year old multiorgan cadaveric donor, preparation of the graft and recipient's stumps, transplantation of the hands, which included bone fixation, arterial and venous anastomoses, nerve suture, joining of tendons and muscles, and skin closure. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil. An intensive rehabilitation program was performed. Follow-up included immunological tests, skin biopsies, arteriography, bone scintigraphy, electromyography and brain functional magnetic resonance imaging.


RESULTS
No surgical complications, infectious complications and graft-versus-host-disease occurred. Two episodes of acute skin rejection were demonstrated and they were completely reversed increasing steroid dose. Nerve regeneration and cortical reorganization were shown. Sensorimotor recovery was encouraging and life quality improved.


CONCLUSIONS
This double hand transplantation showed that conventional immunosuppressive protocol is effective and safe as well as that functional results are at least as good as those achieved in replanted upper extremities.
Dubernard
J M
JM
Service de chirurgie et de médecine de la transplantation, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France. jean-michel.dubernard@chu-lyon.fr
Henry
P
P
Parmentier
H
H
Vallet
B
B
Vial
D
D
Badet
L
L
Petruzzo
P
P
Lefrançois
N
N
Lanzetta
M
M
Owen
E
E
Hakim
N
N
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D001706:Biopsy; D002102:Cadaver; D002540:Cerebral Cortex; D006085:Graft Survival; D006230:Hand Injuries / Q000601:surgery*; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D009048:Motor Skills; D009416:Nerve Regeneration; D011183:Postoperative Complications; D013524:Surgical Flaps; D016896:Treatment Outcome
D007166:Immunosuppressive Agents