title: Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review.
abstract: The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts. Clinical cases of HAT published between 1999 and 2011 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Infectious, metabolic, and oncological complications because of IS therapy were recorded. Twenty-eight patients were reported in 56 clinical manuscripts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (±19.04) points on the DASH score after HAT (P = 0.005). Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. The presence of intrinsic muscle function was observed in 57% of the recipients. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. Three grafts were lost to follow-up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Fifty-two complications caused by IS agents were reported, and they were successfully managed medically or surgically. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University Hospital La Paz, Madrid, Spain. landinsurgery@gmail.com
authors.forename: Luis
authors.initials: L
authors.lastname: Landin
authors.forename: Jorge
authors.initials: J
authors.lastname: Bonastre
authors.forename: Cesar
authors.initials: C
authors.lastname: Casado-Sanchez
authors.forename: Jesus
authors.initials: J
authors.lastname: Diez
authors.forename: Marina
authors.initials: M
authors.lastname: Ninkovic
authors.forename: Marco
authors.initials: M
authors.lastname: Lanzetta
authors.forename: Massimo
authors.initials: M
authors.lastname: del Bene
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
authors.forename: Theresa
authors.initials: T
authors.lastname: Hautz
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Lovic
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: Abelardo
authors.initials: A
authors.lastname: García-de-Lorenzo
authors.forename: Cesar
authors.initials: C
authors.lastname: Casado-Perez
mesh_terms: D000328:Adult; D001132:Arm / Q000502:physiology; D004185:Disability Evaluation; D005260:Female; D006225:Hand / Q000502:physiology; D063987:Hand Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D012086:Reoperation; D012782:Shoulder / Q000502:physiology; D014184:Transplantation, Homologous; D016896:Treatment Outcome