Risks of allogeneic hand transplantation.
A patient undergoing allogeneic hand transplantation needs lifelong immunosuppression with the risk of serious side effects, including life-threatening disease. The question remains: does the eventual improvement in function justify the risk? To answer this question, we try to assess the risks based on a large body of cumulative data derived from more 200,000 kidney transplants using the Collaborative Transplantation Study (CTS). Only selective data which apply to a patient population aged between 15-40 years were used (n = 58,310). Data are compared to the literature references and show superiority with respect to patient numbers, statistics, actuality, and methodology. The CTS data show that the incidence of de novo malignancies is lower than previously reported. The risk of developing any form of cancer is approximately 3%, of developing a skin cancer 1.1%, and of developing a lymphoma 0.58% within 5 years after transplantation. The risk of suffering from a cataract is 11% after 5 years, which is also lower than previously reported. Although the incidence of side effects (particularly malignant disease) is likely to be lower than previously thought, the risk-benefit question must be answered by each hand surgeon for each individual patient.
Baumeister
Steffen
S
Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany. stbaumeister@yahoo.com
Kleist
Christian
C
Döhler
Bernd
B
Bickert
Bertold
B
Germann
Günter
G
Opelz
Gerhard
G
D000293:Adolescent; D000328:Adult; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D063987:Hand Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology; D016030:Kidney Transplantation / Q000276:immunology; D009369:Neoplasms / Q000453:epidemiology; D009422:Nervous System Diseases / Q000453:epidemiology; D009894:Opportunistic Infections / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents