20-Year Follow-up of Two Cases of Bilateral Hand Transplantation

Schneeberger, Stefan; Petruzzo, Palmina; Morélon, Emmanuel; Hautz, Theresa; Kanitakis, Jean; Weißenbacher, Annemarie; Messner, Franka; Bernardon, Laurence; Seulin, Christian; Berchtold, Valeria; Ninković, Marina; Öfner, Dietmar; Badet, Lionel; Gazarian, Aram; Lanzettà, Marco; Margreiter, Raimund; Dubernard, Jean‐Michel

doi:10.1056/nejmc2017711

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…This historical cornerstone pushed the boundaries of research, resulting in the unexpected and rapid growth of this newly developed medical field. Numerous clinical procedures have been performed: upper limb, lower limb, larynx, uterus, penis, tendons, abdominal wall, nerves, face, tongue and scalp transplantations [ 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. The main characteristic of composite allografts is their complexity, as determined by their histological heterogenicity, comprising multiple tissue types (skin, fat, muscles, nerves, lymphatic ganglia, bone, bone marrow, cartilage and ligaments), each presenting a different grade of immunogenicity [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring Costimulatory Blockade-Based Immunologic Strategies in Transplantation: Are They a Promising Immunomodulatory Approach for Organ and Vascularized Composite Allotransplantation?

Grosu-Bularda,

Hodea,

Zamfirescu

et al. 2024

JPM

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The field of transplantation, including the specialized area of vascularized composite allotransplantation (VCA), has been transformed since the first hand transplant in 1998. The major challenge in VCA comes from the need for life-long immunosuppressive therapy due to its non-vital nature and a high rate of systemic complications. Ongoing research is focused on immunosuppressive therapeutic strategies to avoid toxicity and promote donor-specific tolerance. This includes studying the balance between tolerance and effector mechanisms in immune modulation, particularly the role of costimulatory signals in T lymphocyte activation. Costimulatory signals during T cell activation can have either stimulatory or inhibitory effects. Interfering with T cell activation through costimulation blockade strategies shows potential in avoiding rejection and prolonging the survival of transplanted organs. This review paper aims to summarize current data on the immunologic role of costimulatory blockade in the field of transplantation. It focuses on strategies that can be applied in vascularized composite allotransplantation, offering insights into novel methods for enhancing the success and safety of these procedures.

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Section: Introductionmentioning

confidence: 99%

Exploring Costimulatory Blockade-Based Immunologic Strategies in Transplantation: Are They a Promising Immunomodulatory Approach for Organ and Vascularized Composite Allotransplantation?

Grosu-Bularda,

Hodea,

Zamfirescu

et al. 2024

JPM

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“…To date, more than 120 upper extremity and 46 face transplants have been performed worldwide along with other types of VCAs [ 2 , 3 ]. Successful short- and long-term transplantation outcomes demonstrate VCA as viable treatment option for patients suffering large tissue defects or loss of limbs and for whom there are no conventional reconstructive options [ 4 – 7 ]. Currently, around 185,000 amputations take place in the US every year due to trauma, oncological resection, or severe burn, with the total number of amputees expected to reach 3.5 million by 2050 [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Methods of ex vivo analysis of tissue status in vascularized composite allografts

Ton,

Salehi,

Abasi

et al. 2023

J Transl Med

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Vascularized composite allotransplantation can improve quality of life and restore functionality. However, the complex tissue composition of vascularized composite allografts (VCAs) presents unique clinical challenges that increase the likelihood of transplant rejection. Under prolonged static cold storage, highly damage-susceptible tissues such as muscle and nerve undergo irreversible degradation that may render allografts non-functional. Skin-containing VCA elicits an immunogenic response that increases the risk of recipient allograft rejection. The development of quantitative metrics to evaluate VCAs prior to and following transplantation are key to mitigating allograft rejection. Correspondingly, a broad range of bioanalytical methods have emerged to assess the progression of VCA rejection and characterize transplantation outcomes. To consolidate the current range of relevant technologies and expand on potential for development, methods to evaluate ex vivo VCA status are herein reviewed and comparatively assessed. The use of implantable physiological status monitoring biochips, non-invasive bioimpedance monitoring to assess edema, and deep learning algorithms to fuse disparate inputs to stratify VCAs are identified.

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“…In search of more acceptable therapeutic alternatives for patients with severe upper limb trauma, cadaveric donor hand transplantation has been performed since 1999, becoming a therapeutic reality for patients, largely restoring functionality and improving patients' quality of life. The first successful case was performed in the United States in Louisville, Kentucky, and is currently the hand transplant with the longest long-term follow-up with good functionality and few episodes of acute rejection [ 5 ]. After an upper limb transplant, 75% of patients recover their working life and become independent, improving their quality of life.…”

Section: Introductionmentioning

confidence: 99%

Descriptive Study of Patients With Upper Limb Amputation As Possible Candidates for a Hand Transplant in Medellín, Colombia

Cotes¹,

Rios²,

Sañudo³

et al. 2022

Cureus

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The amputation of the upper limb, especially of the hand, is a serious trauma with significant functional and psychological impact. Treatment options include adaptation to the stump, use of prostheses, and composite tissue transplantation. Unfortunately, in Colombia, to date, there are no epidemiological data that characterize the sociodemographic and clinical variables of patients with upper limb amputation. ResultsFrom a sample of 443 amputee patients, eight were selected that met the inclusion criteria. There were 7/8 men (87%) aged 43 years. A total of 75% came from rural areas. In 3/8 patients, there was amputation of the dominant limb. The most common mechanisms were shear trauma and crushing in the context of an occupational accident. A total of 50% had a complete extra-hospital amputation, and reimplantation was not attempted in any of the cases. The most frequent levels of amputation were the proximal and distal third of the forearm. The longest follow-up time was 12 months. Only two patients mentioned the possibility of using a prosthesis during rehabilitation. ConclusionsThree young patients were identified, without comorbidities, with amputation of the dominant limb in the context of an occupational accident and without the possibility of rehabilitation with prostheses who benefit from a possible future hand transplant. However, it is necessary to implement a composite tissue transplantation program and public health policies that allow this procedure to be performed in Colombia.

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20-Year Follow-up of Two Cases of Bilateral Hand Transplantation

Cited by 9 publications

References 4 publications

Exploring Costimulatory Blockade-Based Immunologic Strategies in Transplantation: Are They a Promising Immunomodulatory Approach for Organ and Vascularized Composite Allotransplantation?

Exploring Costimulatory Blockade-Based Immunologic Strategies in Transplantation: Are They a Promising Immunomodulatory Approach for Organ and Vascularized Composite Allotransplantation?

Methods of ex vivo analysis of tissue status in vascularized composite allografts

Descriptive Study of Patients With Upper Limb Amputation As Possible Candidates for a Hand Transplant in Medellín, Colombia

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