Outcomes after bilateral hand allotransplantation: a risk/benefit ratio analysis
| Autor: | Michel Guillot, Lionel Badet, Jean Kanitakis, H Parmentier, Aram Gazarian, Christophe Vial, Jean-Michel Dubernard, Palmina Petruzzo, Vincent Guigal, Emmanuel Morelon |
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| Rok vydání: | 2014 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty medicine.medical_treatment Hand Transplantation Single Center Risk Assessment Tacrolimus Risk–benefit ratio Hand strength Activities of Daily Living Medicine Humans Transplantation Homologous Antilymphocyte Serum Hand Strength business.industry Graft Survival Immunosuppression Recovery of Function Mycophenolic Acid Surgery Transplantation Amputation Patient Satisfaction Touch Prednisone Female business Hand transplantation Immunosuppressive Agents Allotransplantation Follow-Up Studies |
| Zdroj: | Annals of surgery. 261(1) |
| ISSN: | 1528-1140 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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