title: Bilateral trans-humeral arm transplantation: result at 2 years.
abstract: Unilateral and bilateral hand transplantations have been performed worldwide with good mid-term functional results. An above-elbow bilateral transplantation was performed in a 29-year-old male patient from a fully HLA-mismatched donor. Alemtuzumab induction and steroid-free maintenance immunosuppression with tacrolimus and mycophenolate was used. Due to acute rejection, steroids were introduced at 6 months. Three acute rejection episodes occurred, one treated with alemtuzumab. New-onset diabetes after transplant, dyslipemia and worsening of previous high blood pressure required treatment. At 26 months post-transplantation, the patient has excellent elbow active movement, active flexion and extension of the thumb and fingers, useful sensation and a gainful job. Based on the functional results of the case reported, bilateral trans-humeral transplantation could be a viable treatment for selected bilateral above-elbow amputees.
authors.affiliation: Reconstructive surgery, Clínica Cavadas, Valencia, Spain. pcavadas@clinicacavadas.es
authors.forename: P C
authors.initials: PC
authors.lastname: Cavadas
authors.forename: J
authors.initials: J
authors.lastname: Ibáñez
authors.forename: A
authors.initials: A
authors.lastname: Thione
authors.forename: L
authors.initials: L
authors.lastname: Alfaro
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000671:Amputation, Surgical; D000911:Antibodies, Monoclonal / Q000494:pharmacology; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000494:pharmacology; D001132:Arm / Q000637:transplantation*; D048909:Diabetes Complications / Q000175:diagnosis; D006680:HLA Antigens / Q000276:immunology; D063987:Hand Transplantation; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D013256:Steroids / Q000737:chemistry; D016559:Tacrolimus / Q000494:pharmacology; D014180:Transplantation / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D013256:Steroids; D000074323:Alemtuzumab; D009173:Mycophenolic Acid; D016559:Tacrolimus