title: Assessment of vascular function of hand allografts.
abstract: BACKGROUND
  Insufficiency of blood vessels supplying a limb allograft may lead to loss of the extremity. Thus, a regular evaluation of perfusion of transplants seems a reasonable approach. The purpose of the present study was assessment of allograft perfusion by means of non-invasive methods.
  
  
  METHODS
  Six hand allografts transplanted in 5 patients were included in the study group. The transplant procedure occurred on average 45 months before. The study group comprised 2 allografts at forearm level, 2 transplants of the arm, and 1 bilateral transplant of the forearm. Parameters of blood flow using Doppler ultrasonography, impedance plethysmography, Doppler measurement of segmental pressures, optical pulse oscillography (OPO), and thermography were performed in all participants.
  
  
  RESULTS
  DUS revealed increased resistive index in ulnar arteries of transplant hands compared to native hands and an altered blood supply was confirmed by IP. Flow-mediated dilatation within the transplanted extremity was abnormal in most patients and was inversely correlated with number of episodes of acute rejection. Analysis of oscillographic spectrum revealed flattening of the dicrotic notch in transplant hands. A tendency for lower temperature of the skin of transplanted hands compared to native extremities was also observed.
  
  
  CONCLUSIONS
  In asymptomatic patients after limb transplantation, non-invasive methods disclosed discreet abnormalities of graft perfusion. Thus, regular measurement of perfusion parameters using these methods appears to be a promising approach to detect early and potentially reversible disturbances of blood supply. Further observational studies are required to determine its clinical significance.
authors.affiliation: Departament of Angiology, Hypertension and Diabetology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Małecki
authors.affiliation: Departament of Angiology, Hypertension and Diabetology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Gacka
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Boratyńska
authors.affiliation: Department of Physiotherapy, Wrocław Medical University, Wrocław, Poland.
authors.forename: Ilias
authors.initials: I
authors.lastname: Dumas
authors.affiliation: Department of Orthopedic Trauma, Subdivision of Limb Replantation, Microsurgery, and Hand Surgery, Pediatric Orthopaedics and Spinal Surgery, St. Hedwig of Silesia Hospital, Trzebnica, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jabłecki
authors.affiliation: Department of Orthopedic Trauma, Subdivision of Limb Replantation, Microsurgery, and Hand Surgery, Pediatric Orthopaedics and Spinal Surgery, St. Hedwig of Silesia Hospital, Trzebnica, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Chełmoński
authors.affiliation: Department of Physiotherapy, Wrocław Medical University, Wrocław, Poland.
authors.forename: Zanna
authors.initials: Z
authors.lastname: Fiodorenko-Dumas
authors.affiliation: Departament of Angiology, Hypertension and Diabetology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Rajmund
authors.initials: R
authors.lastname: Adamiec
authors.affiliation: Departament of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
mesh_terms: D000328:Adult; D064595:Composite Tissue Allografts / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D063987:Hand Transplantation; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010992:Plethysmography, Impedance; D011183:Postoperative Complications / Q000175:diagnosis*; D018615:Ultrasonography, Doppler, Color