title: Outcomes after hand and upper extremity transplantation.
abstract: Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify. Despite encouraging functional outcomes, current immunosuppressive regimens with their deleterious side-effect profile remain a major concern for a life-changing but not life-saving type of transplant. In addition, a growing number of recipients with progressively longer follow-up prompt the need to investigate potential long-term sequelae, such as chronic rejection. This review will discuss the current state of HUET, summarizing outcome data on graft survival, motor and sensory function, as well as immunosuppressive treatment. The implications of these findings for VCA in terms of achievements and challenges ahead will then be discussed.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jaimie T
authors.initials: JT
authors.lastname: Shores
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Ruprecht-Karls University Heidelberg Medical Faculty, Heidelberg, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Malek
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: W P Andrew
authors.initials: WPA
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. brandacher@jhmi.edu.
authors.forename: Gerald
authors.initials: G
authors.lastname: Brandacher
mesh_terms: D064595:Composite Tissue Allografts / Q000276:immunology / Q000502:physiology; D006085:Graft Survival; D063987:Hand Transplantation / Q000009:adverse effects / Q000379:methods / Q000639:trends; D006801:Humans; D007165:Immunosuppression Therapy; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery*; D063986:Vascularized Composite Allotransplantation / Q000009:adverse effects / Q000379:methods / Q000639:trends