The International Registry on Hand and Composite Tissue Transplantation.
BACKGROUND
The International Registry on Hand and Composite Tissue Transplantation was founded in May 2002, and the analysis of all cases with follow-up information up to July 2010 is presented here.


METHODS
From September 1998 to July 2010, 49 hands (17 unilateral and 16 bilateral hand transplantations, including 1 case of bilateral arm transplantation) have been reported, for a total of 33 patients. They were 31 men and 2 women (median age 32 years). Time since hand loss ranged from 2 months to 34 years, and in 46% of cases, the level of amputation was at wrist. Immunosuppressive therapy included tacrolimus, mycophenolate mofetil, sirolimus, and steroids; polyclonal or monoclonal antibodies were used for induction. Topical immunosuppression was also used in several cases. Follow-up ranges from 1 month to 11 years.


RESULTS
One patient died on day 65. Three patients transplanted in the Western countries have lost their graft, whereas until September 2009, seven hand grafts were removed for noncompliance to the immunosuppressive therapy in China. Eighty-five percent of recipients experienced at least one episode of acute rejection within the first year, and they were reversible when promptly treated. Side effects included opportunistic infections, metabolic complications, and malignancies. All patients developed protective sensibility, 90% of them developed tactile sensibility, and 82.3% also developed a discriminative sensibility. Motor recovery enabled patients to perform most daily activities.


CONCLUSIONS
Hand transplantation is a complex procedure, and its success is based on patient's compliance and his or her careful evaluation before and after transplantation.
Department of Transplantation, Hopital Edouard Herriot, Lyon, France. petruzzo@medicina.unica.it
Palmina
P
Petruzzo
Marco
M
Lanzetta
Jean-Michel
JM
Dubernard
Luis
L
Landin
Pedro
P
Cavadas
Raimund
R
Margreiter
Stephan
S
Schneeberger
Warren
W
Breidenbach
Christina
C
Kaufman
Jerzy
J
Jablecki
Frédéric
F
Schuind
Christian
C
Dumontier
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000671:Amputation, Surgical; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D063987:Hand Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010349:Patient Compliance; D012042:Registries; D020123:Sirolimus / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus