Hand Transplantation: Current Status and Immunologic Obstacles

Park, Seong H.; Eun, Seok Chan; Kwon, Sung Tack

doi:10.6002/ect.2018.0163

Cited by 24 publications

(21 citation statements)

References 41 publications

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“…Furthermore, this procedure has presented significant advances in microsurgical techniques and immunosuppressive treatment during the last 20 years, which has allowed obtaining transplant survival rates of up to 98% in the cases of isolated unilateral or bilateral hand transplants [ 12 ]. Currently, more than 107 transplants have been performed worldwide, with good aesthetic and functional results due to their similar appearance, weight, texture, and intuitive control [ 13 ]. Unlike solid organ transplants, hand transplantation is not a vital surgery, but it does manage to regain functionality by improving the quality of life of patients [ 14 , 15 ].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…Anesthesia typically includes a combination of general anesthesia and regional blocks for vasodilation and pain control. 8,19 The recipient extremity(s) is dissected with the labeling of all components. 19 Once the VCA organs arrive in the recipient OR, the extremity (s) is dissected at the back table.…”

Section: Recipient Operationmentioning

confidence: 99%

“…A typical rehabilitation protocol includes physical therapy, occupational therapy, electrotherapy, cognitive therapy, splinting, and edema and scar management. 19,25,26 Specific protocols differ by an institution and are modified to meet unique patient needs. Overall, the goals of rehabilitation are to regain hand function and reorganize cortical structure.…”

Section: Postoperative Management Rehabilitationmentioning

confidence: 99%

Advanced Amputation Techniques in Orthopedic Surgery: Hand Transplantation

Polascik

Mundy

Cendales

2021

Techniques in Orthopaedics

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Hand transplantation is a form of vascularized composite allotransplantation under clinical research, which presents a novel therapy to amputation. Preparation for hand transplantation requires a carefully selected candidate, an extensive preoperative workup, and organization of a large, multidisciplinary team and a robust research infrastructure, among others. Performing a hand transplant involves a complex coordination of the teams from organ procurement and recipient surgery. Postoperatively, hand transplant recipients must undergo extensive occupational therapy, monitoring, and immunosuppression for as long as they have the transplant. Allograft rejection is a common complication of hand transplantation. However, complications may also be secondary to immunosuppression, which represents an important consideration in the decision-making between risk versus benefit. Advances in vascular surgery, immunology, microsurgery, and hand surgery allowed for the first successful hand transplant in 1998, and now over 150 hand transplants have been performed worldwide with preliminary positive functional outcomes. Both positive and negative psychosocial outcomes have been recorded. As an experimental procedure, many parameters, including patient selection criteria, immunosuppression regimens, outcomes, and monitoring protocols, have yet to be standardized. Innovation, systematic study, and practice will move forward the field of hand transplantation. This chapter provides a comprehensive review of key preoperative, intraoperative, and postoperative considerations, complications, and outcomes, as well as areas of active research in vascularized composite allotransplantation.

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“…25 On the other end of the spectrum, 4 patients have lost their grafts as a result of rejection. 26 Other patients have experienced outcomes that fall between these 2 extremes.…”

Section: Eligibility and Patient Selectionmentioning

confidence: 99%

How to Help Patients Considering VCA

2019

AMA Journal of Ethics

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Patients who might benefit from some form of vascularized composite allotransplantation (VCA) can be expected to have prior long-standing relationships with one or more primary care professionals or specialists who are well-positioned to help patients make well-informed decisions about whether and when to pursue VCA. Helping patients decide requires becoming familiar with VCA, its various forms, eligibility criteria, prior and possible outcomes, and potential risks and benefits. This article shares key points for helping patients.

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Hand Transplantation: Current Status and Immunologic Obstacles

Cited by 24 publications

References 41 publications

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

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

Advanced Amputation Techniques in Orthopedic Surgery: Hand Transplantation

How to Help Patients Considering VCA

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