title: Functional results of the first human double-hand transplantation.
abstract: 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.
authors.affiliation: Service de Chirurgie de Transplantation, Hopital Edouard Herriot, Place d'Arsonval, 69347 Lyon, France. jean-michel.dubernard@chu-lyon.fr
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Dubernard
authors.forename: Palmina
authors.initials: P
authors.lastname: Petruzzo
authors.forename: Marco
authors.initials: M
authors.lastname: Lanzetta
authors.forename: Helen
authors.initials: H
authors.lastname: Parmentier
authors.forename: Xavier
authors.initials: X
authors.lastname: Martin
authors.forename: Marwan
authors.initials: M
authors.lastname: Dawahra
authors.forename: Nadey S
authors.initials: NS
authors.lastname: Hakim
authors.forename: Earl
authors.initials: E
authors.lastname: Owen
mesh_terms: 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