International Registry On Hand and Composite Tissue Transplantation.

Petruzzo, Palmina; Lanzettà, Marco; Dubernard, Jean Michel

doi:10.1097/00007890-201407151-00148

Cited by 130 publications

(271 citation statements)

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“…After the first successful HA under modern immunosuppression [10], more than 50 patients have received transplants worldwide. Although much has been published regarding indications, surgical techniques, recovery and outcomes [25], there is little discussion of post-operative therapy protocols. Surgical technique and post-operative care of HA are akin to those of replantation, and thus many of the treatment and therapy protocols after HA are adapted from the replantation literature [18].…”

Section: Introductionmentioning

confidence: 99%

“…There are reports of intrinsic function by 9 months with neurovegetative function at 12 months after HA at the forearm level [10], and return to work (RTW) as a driver 2 years after transhumeral HA [8]. The timing of sensory function return is far more variable, and improvements continue years post-operatively [8,10,[23][24][25]. Decreased sensation, neuropathic pain and cold intolerance are well documented and relate to sensory neural loss [33].…”

Section: Introductionmentioning

confidence: 99%

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Rehabilitation Following Hand Transplantation

Bueno

Benjamin

Sisk

et al. 2013

Hand (New York, N,Y.)

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Background Hand allotransplantation can restore motor, sensory and cosmetic functions to upper extremity amputees. Conclusions Rehabilitation therapy after hand transplantation follows a progressive increase in activity in parallel with wound healing and nerve regeneration. Careful documentation of progress and outcomes is essential to demonstrate the utility of interventions and to optimize therapy protocols.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rehabilitation Following Hand Transplantation

Bueno

Benjamin

Sisk

et al. 2013

Hand (New York, N,Y.)

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“…Most patients are currently maintained on multi-drug regimens typically including a calcineurin inhibitor (CNI), mycophenolate mofetil (MMF), and steroids. As such, complications arising from these agents are the most commonly reported posthand transplantation and include renal dysfunction, hyperglycemia, and dyslipidemia (1). Importantly, current regimens do not completely prevent acute VCA rejection or chronic graft loss, and alloantibody-mediated rejection also has been reported (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

“…As such, complications arising from these agents are the most commonly reported posthand transplantation and include renal dysfunction, hyperglycemia, and dyslipidemia (1). Importantly, current regimens do not completely prevent acute VCA rejection or chronic graft loss, and alloantibody-mediated rejection also has been reported (1)(2)(3). Furthermore, they require daily administration of several medications, thereby increasing the requirement for strict regimen adherence.…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report.

et al. 2014

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Vascularized composite allotransplantation (VCA) has emerged as a viable limb replacement strategy for selected patients with upper limb amputation. However, allograft rejection has been seen in essentially all reported VCA recipients indicating a requirement for substantial immunosuppressive therapy. Calcineurin inhibitors have served as the centerpiece agent in all reported cases, and CNI-associated complications associated with the broad therapeutic effects and side effects of calcineurin inhibitors have been similarly common. Recently, belatacept has been approved as a calcineurin inhibitor replacement in kidney transplantation, but to date, its use in VCA has not been reported. Herein, we report on the case of a hand transplant recipient who developed recurrent acute rejection with alloantibody formation and concomitant calcineurin inhibitor nephrotoxicity, all of which resolved upon conversion from a maintenance regimen of tacrolimus, mycophenolate mofetil and steroids to belatacept and sirolimus. This case indicates that belatacept may be a reasonable maintenance immunosuppressive alternative for use in VCA, providing sufficient prophylaxis from rejection with a reduced side effect profile, the latter being particularly relevant for nonlife threatening conditions typically treated by VCA.

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“…Vascularized Composite Allotransplantation (VCA) such as hand and face transplants are now a clinical reality with numerous hand and face transplants performed worldwide 12 . Despite the fact that early and intermediate results are favorable and highly encouraging 2 , the requirement of chronic multidrug immunosuppression continues to limit its widespread clinical application.…”

Section: Introductionmentioning

confidence: 99%

A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation (VCA) Research

Ibrahim

Cooney

Shores

et al. 2013

JoVE

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Vascularized Composite Allotransplantation (VCA) such as hand and face transplants represent a viable treatment option for complex musculoskeletal trauma and devastating tissue loss. Despite favorable and highly encouraging early and intermediate functional outcomes, rejection of the highly immunogenic skin component of a VCA and potential adverse effects of chronic multi-drug immunosuppression continue to hamper widespread clinical application of VCA. Therefore, research in this novel field needs to focus on translational studies related to unique immunologic features of VCA and to develop novel immunomodulatory strategies for immunomodulation and tolerance induction following VCA without the need for long term immunosuppression.This article describes a reliable and reproducible translational large animal model of VCA that is comprised of an osteomyocutaneous flap in a MHC-defined swine heterotopic hind limb allotransplantation. Briefly, a well-vascularized skin paddle is identified in the anteromedial thigh region using near infrared laser angiography. The underlying muscles, knee joint, distal femur, and proximal tibia are harvested on a femoral vascular pedicle. This allograft can be considered both a VCA and a vascularized bone marrow transplant with its unique immune privileged features. The graft is transplanted to a subcutaneous abdominal pocket in the recipient animal with a skin component exteriorized to the dorsolateral region for immune monitoring.Three surgical teams work simultaneously in a well-coordinated manner to reduce anesthesia and ischemia times, thereby improving efficiency of this model and reducing potential confounders in experimental protocols. This model serves as the groundwork for future therapeutic strategies aimed at reducing and potentially eliminating the need for chronic multi-drug immunosuppression in VCA. Video LinkThe video component of this article can be found at

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International Registry On Hand and Composite Tissue Transplantation.

Cited by 130 publications

References 0 publications

Rehabilitation Following Hand Transplantation

Rehabilitation Following Hand Transplantation

Tacrolimus to Belatacept Conversion Following Hand Transplantation: A Case Report.

A Modified Heterotopic Swine Hind Limb Transplant Model for Translational Vascularized Composite Allotransplantation (VCA) Research

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