Hand transplantation in the United States: A review of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Database

Abstract

Hand transplantation is the most common application of vascularized composite allotransplantation (VCA). Since July 3, 2014, VCAs were added to the definition of organs covered by federal regulation (the Organ Procurement and Transplantation Network (OPTN) Final Rule) and legislation (the National Organ Transplant Act). As such, VCA is subject to requirements including data submission. We performed an analysis of recipients reported to the OPTN to have received hand transplantation between 1999 and 2018. Forty‐three patients were identified as having been listed for upper extremity transplantation in the United States. Of these, 22 received transplantation prior to July 3, 2014 and 10 from then to December 31, 2018. Of patients transplanted after 2014, posttransplant functional scores included a decrease in Disabilities of the Arm, Shoulder and Hand questionnaire in 3 of 10 patients, Carroll test scores ranging from 9 to 60 of 99, and monofilament testing with protective sensation achieved in 4 of 6 patients. Complications included rejection in nine recipients with Banff scores from II‐IV. One patient experienced graft failure 5 days after transplantation. Of the remaining patients, two were reported as receiving monotherapy and seven receiving dual or triple immunosuppression therapy. The inclusion of VCA in the OPTN Final Rule standardized parameters for safe implementation and data collection.

Non-HLA Antibodies in Hand Transplant Recipients Are Connected to Multiple Acute Rejection Episodes and Endothelial Activation

“…1 Hand vs. kidney: p = 0.001, hand vs. healthy: p < 0.001, kidney vs. healthy: p < 0.001 (Mann-Whitney test). 2 Hand vs. kidney: p = 0.174, hand vs. healthy: p = 0.013, kidney vs. healthy: p = 0.003 (Mann-Whitney test). 3 Hand vs. kidney: p = 0.743, hand vs. healthy: p = 0.010, kidney vs. healthy: p < 0.001 (Mann-Whitney test).…”

“…The results in vascularized composite allotransplantation (VCA) are promising but acute rejection rates are higher than in solid organs recipients, making it a clinically significant problem in VCA [1,2]. Furthermore, an increase in frequency of acute rejection episodes is probably correlated with chronic rejection [3].…”

Regional delivery of immunosuppression for transplantation of vascularized composite allografts: opportunities near and far

“…Although recipients of VCA and recipients of organ transplants receive similar amounts of immunosuppression (3), rejection occurs at higher frequency in clinical VCA than in clinical organ transplants. During the first year after transplantation nearly all VCA undergo a rejection reaction, some repeatedly, while only 10-15% of kidney transplants undergo a proven rejection reaction (4,5). This difference makes it possible to test mitigation of rejection in clinically relevant conditions (e.g., with current regimens of immunosuppression) using relatively few non-human primates.…”

Vascularized composite allotransplantation in the United States: A retrospective analysis of the Organ Procurement and Transplantation Network data after 5 years of the Final Rule

“…A previous publication from our group explored the state of VCAs in a 3‐year period and another reviewed OPTN data on hand transplantations 10,11 . The present manuscript is an effort to analyze all available OPTN data on VCAs, with a focus on all VCA types reported 5 years after the Final Rule.…”

“…A previous publication from our group explored the state of VCAs in a 3-year period and another reviewed OPTN data on hand transplantations. 10,11…”