title: Outcomes after bilateral hand allotransplantation: a risk/benefit ratio analysis.
abstract: BACKGROUND
  The clinic era of composite tissue allotransplantation was inaugurated by hand allotransplantation in 1998, giving rise to many controversies and scepticism because of the lifelong immunosuppression, the unclear risk-benefit ratio, and the uncertain long-term functional results of the procedure. The aim of this study was to evaluate the outcomes and the risk/benefit balance in bilateral hand allotransplantation.
  
  
  METHODS
  The study included 5 cases of bilateral hand allotransplantation performed in a single center, with a follow-up ranging from 3 to 13 years. The recipients (4 men, 1 woman) were young. The level of amputation was distal in all cases except for 2 patients amputated at the midforearm level. All the recipients initially received the same immunosuppressive treatment that included tacrolimus, mycophenolate mofetil, prednisone, and, for induction, antithymocyte globulins.
  
  
  RESULTS
  Patient and graft survival was 100%. All recipients showed adequate sensorimotor recovery (protective and tactile sensitivity and partial recovery of intrinsic muscles), they were able to perform the majority of activities of daily living, and had a normal social life. Most complications occurred in the first posttransplant year and were successfully managed. All recipients experienced at least 1 episode of acute rejection, which was easily reversed by increasing oral steroid dose or by intravenous steroids, except for patient 3, who presented 6 episodes of acute rejection, the latest 2 treated with Campath-1H.
  
  
  CONCLUSIONS
  Although bilateral hand transplantation may be a satisfactory treatment option for amputees, a careful selection of candidates and a rigorous evaluation of recipients after transplantation are imperative.
authors.affiliation: *Department of Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France †Department of Surgery, University of Cagliari, Cagliari, Italy ‡Chirurgie de la Main et du Membre Supérieur, Polyclinique Orthopédique de Lyon, Lyon, France §Department of Dermatology, Edouard Herriot Hospital, Lyon, France ¶Institut des Sciences et Techniques de la Réadaptation, Claude Bernard Lyon I University, Lyon, France ‖Rehabilitation Centre "Romans Ferrari," Miribel, France **Groupe Hospitalier Est, Hôpital neurologique, Centre de Référence en Pathologie Neuromusculaire Rhône-Alpes, Lyon, France ††Université de Lyon, Lyon, France.
authors.forename: Palmina
authors.initials: P
authors.lastname: Petruzzo
authors.forename: Aram
authors.initials: A
authors.lastname: Gazarian
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Helene
authors.initials: H
authors.lastname: Parmentier
authors.forename: Vincent
authors.initials: V
authors.lastname: Guigal
authors.forename: Michel
authors.initials: M
authors.lastname: Guillot
authors.forename: Christophe
authors.initials: C
authors.lastname: Vial
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Dubernard
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
mesh_terms: D000203:Activities of Daily Living; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D018737:Hand Strength; D063987:Hand Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D017060:Patient Satisfaction; D011241:Prednisone / Q000627:therapeutic use; D020127:Recovery of Function; D018570:Risk Assessment; D016559:Tacrolimus / Q000627:therapeutic use; D014110:Touch; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus