18-month outcomes of heterologous bilateral hand transplantation in a child: a case report

Amaral, Sandra; Kessler, Sudha Kilaru; Levy, Todd J.; Gaetz, William; McAndrew, Christine; Chang, Benjamin; Lopez, Sonya; Braham, Emily; Humpl, Deborah; Hsia, Michelle; Ferry, Kelly A; Xu, Xiaowei; Elder, David E.; Lefkowitz, Debra S.; Feudtner, Chris; Thibaudeau, Stéphanie; Lin, Ines C.; Kovach, Stephen J.; Schwartz, Erin Simon; Bozentka, David J.; Carrigan, Robert B.; Steinberg, David R.; Kanchwala, Suhail; Zlotolow, Dan A.; Kozin, Scott H.; Jensen, Frances E.; Bryant, Phillip R.; Shaked, Abraham; Levine, Matthew H.; Levin, L. Scott

doi:10.1016/s2352-4642(17)30012-3

Cited by 44 publications

(36 citation statements)

References 29 publications

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“…A single case of bilateral distal forearm level transplantation was performed on an 8‐year‐old child at our institution who had previously undergone quadruple limb amputations due to sepsis . He had also previously received a living donor kidney transplant and was therefore already immunosuppressed.…”

Section: Methodsmentioning

confidence: 99%

“…A single case of bilateral distal forearm level transplantation was performed on an 8-year-old child at our institution who had previously undergone quadruple limb amputations due to sepsis. 8 He had also previously received a living donor kidney transplant and was therefore already immunosuppressed. He was listed with UNOS for bilateral hand transplant with the following listing information: age 8 ± 2 years, ABO blood type A+, PRA 0%, any CMV or EBV status (recipient both positive), African American ethnicity, and male or female donor acceptable.…”

Section: Case Reportmentioning

confidence: 99%

“…who was previously on lifelong immunosuppression for a prior renal transplant. 8 While the donor population for VCAs has not been extensively studied, it can be confidently stated that there are far fewer potential pediatric VCA donors than adult VCA donors. Thus, as VCAs are extended to the pediatric population, the number of donors is certain to be a limiting factor in these procedures.…”

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confidence: 99%

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Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Mendenhall

Sawyer

West

et al. 2019

Pediatric Transplantation

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Listing the world's first pediatric bilateral hand transplant patient for a donor posed many challenges including matching the appropriate donor age, bone size, skin tone, and growth potential in an already limited donor population. This study describes the prevalence and distribution of potential pediatric VCA donors in the United States. We assessed the UNOS database from 2008 to 2015 to identify the prevalence of potential pediatric VCA donors. Standard VCA inclusion and exclusion criteria were applied to the dataset for all pediatric solid organ donors. Frequency analyses were performed of characteristics important for VCA matching. The dataset began with 57 300 brain‐dead donors and after applying the inclusion and exclusion criteria including age <18, decreased to 4663 (8.1%). The number of pediatric potential VCA donors per UNOS region ranged from 11 to 112/year. The majority of pediatric potential VCA donors were blood type O Whites, with the least common profile being blood type AB of “other” ethnicity. The present study confirmed that pediatric VCA donors are rare and may require longer travel times for procurement and listing at multiple centers in order to find a suitable donor. This will be a limiting factor for the expansion of pediatric VCA.

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Section: Methodsmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

mentioning

confidence: 99%

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Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Mendenhall

Sawyer

West

et al. 2019

Pediatric Transplantation

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“…The vascularized composite tissue allotransplantation (VCA) occurred at the Children's Hospital of Philadelphia (CHOP), six years after bilateral hand and foot amputation at age two resulting from septic shock. 8 Renal transplantation had occurred previously. VCA resulted in reafferentation of the medial, ulnar, and radial nerves serving hand somatosensation and motor function.…”

Section: Methodsmentioning

confidence: 99%

Massive cortical reorganization is reversible following bilateral transplants of the hands: evidence from the first successful bilateral pediatric hand transplant patient

Gaetz

Kessler

Roberts

et al. 2017

Ann Clin Transl Neurol

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In this repeated measures case study, we show that sensory deafferentation after limb amputation leads to changes in cortical somatotopic maps which are reversible after restoration of sensory input. Using magnetoencephalography (MEG), we observed in a child with bilateral hand transplants large‐scale shifts in somatosensory lip cortical representation from anatomic hand area to anatomic face region. After recovery of tactile sensation in the digits, responses to finger stimulation were localized to orthotopic sensory cortex, but with atypical electrophysiologic features (amplitude and frequencies).

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“…Our hypothetical treatment approach for this obvious military medical challenge is outlined in this paper. Recently, there has been growing evidence for the successful application of ex vivo perfusion in solid organ transplantation [13][14][15][16][17]. Figure 1 shows the basic scheme of a machine perfusion system.…”

Section: Introductionmentioning

confidence: 99%

Ex vivo limb perfusion for traumatic amputation in military medicine

Kaltenborn

Krezdorn

Hoffmann³

et al. 2020

Military Med Res

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Background: Limb loss has a drastic impact on a patient's life. Severe trauma to the extremities is common in current military conflicts. Among other aspects, "life before limb" damage control surgery hinders immediate replantation within the short post-traumatic timeframe, which is limited in part by the ischemic time for successful replantation. Ex vivo limb perfusion is currently being researched in animal models and shows promising results for its application in human limb replantation and allotransplantation.

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18-month outcomes of heterologous bilateral hand transplantation in a child: a case report

Cited by 44 publications

References 29 publications

Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States?

Massive cortical reorganization is reversible following bilateral transplants of the hands: evidence from the first successful bilateral pediatric hand transplant patient

Ex vivo limb perfusion for traumatic amputation in military medicine

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