title: First human double hand transplantation: efficacy of a conventional immunosuppressive protocol.
abstract: Based on the results achieved in single human hand transplantations, we decided to perform the first double hand transplantation with a conventional immunosuppressive protocol in a patient with a high potential for functional recovery. Two years after transplantation the efficacy and the safety of this immunosuppressive protocol are evaluated. The recipient was a 33-yr-old man suffering from a traumatic amputation of both hands in 1996. Five HLA-A, -B, and -DR mismatches were present with the donor; T and B cell cross-match was negative. Immunosuppressive protocol included tacrolimus, prednisone, mycophenolate mofetil and, for induction, antithymocyte globulins and then anti CD25 monoclonal antibody. Reconstitution of lymphocyte populations proceeded normally. Neither anti-HLA antibodies nor chimerism in peripheral blood were detected. Two episodes of acute rejection characterized by maculopapular lesions occurred on days 53 and 82 after transplantation. Skin biopsies revealed a dermal lymphocytic infiltrate. Both episodes were completely and rapidly reversed by topical clobetasol and increased systemic corticosteroid therapy. The only side-effects related to treatment were reversible serum sickness and hyperglycemia. No infectious complications and malignancies occurred. No signs of graft-versus-host disease have been detected. This case of double hand transplantation shows that conventional immunosuppression is effective and safe to ensure survival and functional recovery of the grafted limb.
authors.affiliation: Service de Chirurgie de Transplantation, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Palmina
authors.initials: P
authors.lastname: Petruzzo
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Revillard
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Marco
authors.initials: M
authors.lastname: Lanzetta
authors.forename: Nadey S
authors.initials: NS
authors.lastname: Hakim
authors.forename: Nicole
authors.initials: N
authors.lastname: Lefrançois
authors.forename: Earl
authors.initials: E
authors.lastname: Owen
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Dubernard
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D006084:Graft Rejection / Q000188:drug therapy; D006085:Graft Survival; D006230:Hand Injuries / Q000601:surgery; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents