Living-donor nerve transplantation for global obstetric brachial plexus palsy.
The first reported case of live-donor nerve transplantation is presented, performed in an 8-month-old infant with global obstetric brachial plexus palsy (OBPP) and four root avulsions who had undergone prior sural nerve autografting at 3 months. Cross-chest C7 nerve transfer and temporary tacrolimus/prednisone immunosuppression were utilized. Acute rejection was prevented, with no observable complications from the immunosuppressive medications, ipsilateral deficits resulting from the use of the contralateral C7 root as a donor nerve, or untoward effects on growth and development occurring over a 2-year follow-up period. Although some return of sensory and motor responses on nerve conduction studies was documented, the failure to observe a clinically significant functional improvement in the affected limb directly attributable to the transplant may have been due to performing the procedure too late and/or inadequate follow-up. Results of additional cases performed earlier than in this patient with longer follow-up will need to be evaluated to determine whether the procedure proves to be a viable therapeutic option for treatment of global OBPP with four or five root avulsions.
Gruber
Scott A
SA
Division of Immunology and Organ Transplantation, Department of Surgery, Houston, TX, USA.
Mancias
Pedro
P
Swinford
Rita D
RD
Prashner
Heather R
HR
Clifton
Jorge
J
Henry
Mark H
MH
D000328:Adult; D001365:Axilla / Q000294:innervation; D001917:Brachial Plexus / Q000503:physiopathology / Q000601:surgery*; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D019520:Living Donors; D008297:Male; D009046:Motor Neurons / Q000502:physiology; D016067:Nerve Transfer; D009431:Neural Conduction / Q000502:physiology; D010246:Paralysis, Obstetric / Q000601:surgery*; D011826:Radial Nerve / Q000503:physiopathology; D011930:Reaction Time / Q000502:physiology; D012677:Sensation / Q000502:physiology; D013126:Spinal Nerve Roots / Q000293:injuries; D013497:Sural Nerve / Q000637:transplantation*; D014459:Ulnar Nerve / Q000503:physiopathology
D007166:Immunosuppressive Agents