Functional results of the first human double-hand transplantation.
OBJECTIVE
Objective of this study was to analyze fifteen months after surgery the sensorimotor recovery of the first human double hand transplantation.


BACKGROUND
As for any organ transplantation the success of composite tissue allografts such as a double hand allograft depends on prevention of rejection and its functional recovery.


METHODS
The recipient was a 33-year-old man with bilateral amputation. Surgery included procurement of the upper extremities from a multiorgan cadaveric donor, preparation of the graft and recipient's stumps; then, bone fixation, arterial and venous anastomoses, nerve sutures, joining of tendons and muscles and skin closure. Rehabilitation program included physiotherapy, electrostimulation and occupational therapy. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil and, for induction, antithymocyte globulins and then CD25 monoclonal antibody were added. Sensorimotor recovery tests and functional magnetic resonance imaging (fMRI) were performed to assess functional return and cortical reorganization. All the results were classified according to Ipsen's classification.


RESULTS
No surgical complications occurred. Two episodes of skin acute rejection characterized by maculopapular lesions were completely reversed increasing steroid dose within 10 days. By fifteen months the sensorimotor recovery was encouraging and the life quality improved. fMRI showed that cortical hand representation progressively shifted from lateral to medial region in the motor cortex.


CONCLUSIONS
Even though at present this double hand allograft, treated using a conventional immunosuppression, allowed to obtain results at least as good as those achieved in replanted upper extremities, longer follow-up will be necessary to demonstrate the final functional restoration.
Dubernard
Jean Michel
JM
Service de Chirurgie de Transplantation, Hopital Edouard Herriot, Place d'Arsonval, 69347 Lyon, France. jean-michel.dubernard@chu-lyon.fr
Petruzzo
Palmina
P
Lanzetta
Marco
M
Parmentier
Helen
H
Martin
Xavier
X
Dawahra
Marwan
M
Hakim
Nadey S
NS
Owen
Earl
E
D000328:Adult; D000673:Amputation, Traumatic / Q000523:psychology / Q000601:surgery*; D063987:Hand Transplantation; D006801:Humans; D008297:Male; D016377:Organ Transplantation / Q000502:physiology / Q000523:psychology / Q000534:rehabilitation*; D020127:Recovery of Function; D016896:Treatment Outcome