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

Abstract

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.

Facial and Hand Allotransplantation

“…For each case a precise plan and in some cases development of novel reconstruction techniques are required Landin et al 2012). At present, definite recommendations regarding the maximum duration of ischemia do not exist; however, ischemia time should be kept as short as possible and not exceed 10 hours.…”

“…As mentioned above, the functional outcome after transplantation at more proximal levels requires prolonged rehabilitation and is overall less consistent (Landin et al 2012). The functional return in these cases may continue to improve during the first 5 years after trans-…”

Concomitant Face/Upper Extremity Allotransplantation

“…Sensory and motor recovery in hand transplant recipients has conferred the ability to perform daily activities, including eating, driving, grasping objects, shaving, using the telephone and writing [3 •• ]. Landin et al described improved function following hand transplantation, as reported by patients themselves, using the disabilities of arm, shoulder and hand questionnaire [37]. As with facial transplantation, ongoing motor improvements in hand transplant recipients, including ability to perform fine tasks such as pick up ballbearings, have been observed more than 5 years after transplantation [3 •• , 42].…”

Advances in peripheral nerve regeneration as it relates to VCA

“…1 There has been variable return of motor and sensory function following VCA, which is ultimately dependent on the success of nerve regeneration. [2][3][4] Strategies to improve peripheral nerve regeneration are paramount to this field. This review discusses the current knowledge and practices in the field of peripheral nerve regeneration.…”