The International Registry on Hand and Composite Tissue allotransplantation

Abstract

The International Registry on Hand and Composite Tissue Transplantation includes hand and face allotransplantations: 39 patients who received 57 upper extremity transplantations (18 bilateral and 21 single transplantations--17 right and 4 left allografted hands); and 15 cases of partial or total face allotransplantation. The recipients of upper extremity allotransplantations are: 32 males and 7 females, median age 32 years. In 57.9% of cases, the level of amputation was at the wrist. The followup periods range from 6 months to 13 years. The recipients of face allotransplantations are: 12 males and 3 females, median age 34 years. In the majority of cases, the deficit included cheek, nose, chin, lips, and perioral area. The patients presented impairment of swallowing, eating, and speaking. The follow-up periods range from 8 months to 6 years. In hand and face transplantation, the imunosuppressive therapy included: tacrolimus, mycophenolate mofetil, and steroids. Polyclonal or monoclonal antibodies were used for induction. Within the first post-transplant year, eighty-five percent of hand and face recipients experienced at least one episode of acute rejection, which was reversible when promptly treated. Side-effects included: opportunistic infections, metabolic complications, and malignancies. Hand-grafted patients developed protective sensibility: 90% of them tactile sensibility and 82.3% also a discriminative sensibility. Motor recovery enabled patients to perform most daily activities. Face-grafted patients improved their aesthetic aspects and enhanced some activities such as eating, drinking, and speaking, living a normal social life. Five upper allotransplantation losses occurred. One of these patients who underwent simultaneous face and bilateral hand transplantation died on day 65. Hand and face transplantations are successful procedures, however, careful evaluation of patients before and after transplantation, and their compliance are indispensable.