Malignant Skin Tumor in a Composite Tissue (Bilateral Hand) Allograft Recipient

Landín, Luis; Cavadas, Pedro C.; Ibáñez, Javier; Roger, Ignacio

doi:10.1097/prs.0b013e3181c2a3e6

Cited by 18 publications

(11 citation statements)

References 4 publications

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“…Malignancy was diagnosed in two patients: a surgically controlled basal cell carcinoma (BCC) and a case of medically controlled post‐transplant lymphoproliferative disease (PTLD) [45,46]. One graft was lost because of noncompliance with IS therapy [47], another because of vascular complications immediately after transplantation [23], and a third because of rejection [48].…”

Section: Resultsmentioning

confidence: 99%

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Landín

Bonastre

Díez

et al. 2012

Transplant International

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Summary The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts. Clinical cases of HAT published between 1999 and 2011 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Infectious, metabolic, and oncological complications because of IS therapy were recorded. Twenty‐eight patients were reported in 56 clinical manuscripts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (±19.04) points on the DASH score after HAT (P = 0.005). Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. The presence of intrinsic muscle function was observed in 57% of the recipients. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. Three grafts were lost to follow‐up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Fifty‐two complications caused by IS agents were reported, and they were successfully managed medically or surgically. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols.

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Section: Resultsmentioning

confidence: 99%

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Landín

Bonastre

Díez

et al. 2012

Transplant International

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“…At 11 yr post-transplant, a bilateral hand transplant recipient developed immunopathologically confirmed bullous pemphigoid, an autoimmune bullous dermatosis manifesting with blisters on his chest (recipient skin) and both hand allografts (donor skin) (56). Basal cell carcinoma, the commonest human skin malignancy, developed in two VCA recipients on the recipients' skin: One appeared on the nasal ala one yr after transplantation (57) and the second on the temple of the first human face allograft recipient six yr post-transplantation (unpublished data). A double-hand allograft recipient unexpectedly developed alopecia areata of the scalp (a non-scarring alopecia believed to be of autoimmune origin) shortly after a treated episode of rejection (unpublished data).…”

Section: Limitations and Disadvantagesmentioning

confidence: 99%

Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation

Hautz

Zelger

Weißenbacher

et al. 2013

Clinical Transplantation

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Over 70 hands and 20 faces have been transplanted during the past 13 yr, which have shown good to excellent functional and esthetic outcomes. However, (skin) rejection episodes complicate the post-operative courses of hand and face transplant recipients and are still a major obstacle to overcome after reconstructive allotransplantation. This article summarizes all relevant information on the skin component and rejection of a vascularized composite allograft. As more and more centers plan to implement a vascularized composite allotransplantation (VCA) program, we further develop guidelines and recommendations on collection and processing of skin biopsies from hand and face allograft recipients. This will help to standardize post-operative monitoring, avoid pitfalls for those new in the field and facilitate comparison of data on VCA between centers.

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“…71,72 The most frequent types of malignancies encountered are skin cancer, viral-related cancers, and posttransplant lymphoproliferative disease. 73 With longer follow-up, the development of malignancy may contribute to increased patient mortality. However, there has been at least 1 reported case of malignancy in form of a basal cell carcinoma reported in a hand transplant recipient.…”

Section: Immunosuppression Complicationsmentioning

confidence: 99%

Immunosuppression and Monitoring of Rejection in Hand Transplantation

Schneeberger

Khalifian

Brandacher

2013

Techniques in Hand &Amp; Upper Extremity Surgery

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Advances in vascularized composite allotransplantation over the last decade have achieved significant milestones in basic science and translational research, as well as clinically with highly encouraging functional and immunologic outcomes. However, certain immunologic challenges remain. In particular, although tolerance has been induced to nearly all components of a hand allograft in experimental models, the skin component may still be subject to acute rejection episodes. Currently, conventional immunosuppressive protocols have been successful at preventing allograft loss; however, they have not prevented episodes of acute skin rejection. Furthermore, the profound side effect profile of the life-long, high-dose, multidrug immunosuppression regimen that is necessary to maintain a viable graft alters the risk to benefit ratio of this non-life-saving procedure. Therefore, there must be a concerted effort in the scientific community to develop novel protocols to either minimize immunosuppression or to induce tolerance to the allograft to promote the widespread application of this life-changing procedure.

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Malignant Skin Tumor in a Composite Tissue (Bilateral Hand) Allograft Recipient

Cited by 18 publications

References 4 publications

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation

Immunosuppression and Monitoring of Rejection in Hand Transplantation

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