Report (2017) of the International Registry on Hand and Composite Tissue Allotransplantation (IRHCTT)

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

doi:10.1007/s40472-017-0168-3

Cited by 53 publications

(66 citation statements)

References 8 publications

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“…Such modalities include variations in T AE B cell depletion, steroid-based and steroid-sparing maintenance regimens, switching from calcineurin-based inhibition to rapamycin and/or belatacept, and donor BMC infusion. DSA formation was detected in 3 of 5 VCA patients (#3, 8,9,12,13) who had undergone basiliximab or ATG induction followed by steroid-based maintenance immunosuppression but only in 1 of 5 (patients #4, 5, 6, 7, 10) who had undergone alemtuzumab induction and steroid-sparing maintenance protocols (albeit initially). Perhaps the earlier detection of GV in the latter group and subsequent introduction of additional maintenance steroids halted further progression.…”

Section: Discussionmentioning

confidence: 99%

Graft vasculopathy of vascularized composite allografts in humans: a literature review and retrospective study

Lellouch

Rosales

et al. 2019

Transpl Int

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Mechanisms of chronic rejection of vascularized composite allografts (VCA) remain poorly understood and likely present along a spectrum of highly varied clinicopathological findings. Across both animal and human VCA however, graft vasculopathy (GV) has been the most consistent pathological finding resulting clinically in irreversible allograft dysfunction and eventual loss. A literature review of all reported clinical VCA cases with documented GV up to December 2018 was thus performed to elucidate the possible mechanisms involved. Relevant data extracted include C4d deposition, donor-specific antibody (DSA) formation, extent of human leukocyte antigen (HLA) mismatch, pretransplant panel reactive antibody levels, induction and maintenance immunosuppression used, the number of preceding acute rejection episodes, and time to histological confirmation of GV. Approximately 6% (13 of 205) of all VCA patients reported to date developed GV at a mean of 6 years post-transplantation. 46% of these patients have either lost or had their VCAs removed. Neither C4d nor DSA alone was predictive of GV development; however, when both are present, VCA loss appears inevitable due to progressive GV. Of utmost concern, GV in VCA does not appear to be abrogated by currently available immunosuppressive treatment and is essentially irreversible by the time of diagnosis with allograft loss a likely eventuality.

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Section: Discussionmentioning

confidence: 99%

Graft vasculopathy of vascularized composite allografts in humans: a literature review and retrospective study

Lellouch

Rosales

et al. 2019

Transpl Int

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“…Since the first hand transplant in Lyon, France in 1998 there have been 120 upper limb transplants performed world-wide in 74 patients [4]. The 2017 International Registry on Hand and Composite Tissue Allotransplantation (IRHCTT) presented encouraging results from 66 upper limb cases, with patient survival at 1, 5 and 10 years of 96.7% and graft survival of 86.6% at 5 and 10 years, similar to that of SOT [34].…”

Section: Upper Limb Transplantationmentioning

confidence: 97%

“…Patient survival, as reported in the 2017 IRHCTT, is 96.2%, with 5 reported deaths worldwide [34]. Cause of mortality ranged from non-compliance with medication, to malignancy and death associated with combination transplantation [5].…”

Section: Face Transplantsmentioning

confidence: 99%

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Vascularised Composite Allotransplantation – Basic Science and Clinical Applications

Honeyman

Fries

2019

International Journal of Orthoplastic Surgery

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Vascularised Composite Allotransplantation (VCA) is the top rung of the reconstructive ladder, offering 'like-for like' functional reconstruction for the most devastating tissue loss. There are established centres across Europe, the USA and Asia. Clinical outcomes now extend beyond 20 years. To-date over 130 upper limb and 37 craniofacial VCA's have been performed, with encouraging graft survival and clinical outcomes. Beyond hand and face transplantation novel VCA's have been performed including: functioning allotransplantation of neck organs, penis, uterus and skull and scalp transplants. Like solid organ transplant (SOT) patients, VCA recipients are submitted to the significant side effects of lifelong immunosuppression, however in this case surgery is considered life improving rather than life saving. As clinical feasibility is now well established research focus has shifted to improve the safety profile of VCA. This has included exploring strategies to enable early detection and treatment of acute rejection, defining and better understanding chronic rejection in VCA, and ultimately aiming to induce tolerance. The aim of this review article is to give a concise overview of the clinical and basic science advances in the field of VCA, with particular relevance to the orthoplastic surgeon.

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“…More than 100 such transplants had been reported worldwide by 2018. 4 Although patient survivability surpasses 95% at 10 years, 5 unlike solid organ transplantation, this procedure's primary aim is not to extend life in relatively ill patients but to improve quality of life in relatively healthy patients. 6,7,8,9,10 For both kinds of transplants, life-long immunosuppression, which is necessary to prevent graft rejection or loss, increases the risk of developing oncologic malignancy and metabolic disorders like diabetes mellitus and heightens susceptibility to infections.…”

Section: Commentarymentioning

confidence: 99%

Should a Caregiver's QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant?

Dorante¹,

Devine

Talbot

2019

AMA Journal of Ethics

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A goal of hand and upper extremity transplantation is to return motor and sensory function to an amputee. Given the integral roles of one's hands in activities of daily living and social interaction, however, restoring psychosocial well-being should also be a priority. Based on the authors' experience, double-hand transplantation success depends significantly on strong social support, physical rehabilitation, medication adherence, and social integration. Because caregiving is demanding, tasks should be distributed among members of a patient's family and social network. This article analyzes how to respond to an overwhelmed caregiver by drawing on solid organ transplant literature about caregiver fatigue. CaseC is a quadrilateral amputee who lives with her partner, N. After 2 years of working with prosthetics and outfitting their apartment with assistive devices, N and C have a life together they enjoy.

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Report (2017) of the International Registry on Hand and Composite Tissue Allotransplantation (IRHCTT)

Cited by 53 publications

References 8 publications

Graft vasculopathy of vascularized composite allografts in humans: a literature review and retrospective study

Graft vasculopathy of vascularized composite allografts in humans: a literature review and retrospective study

Vascularised Composite Allotransplantation – Basic Science and Clinical Applications

Should a Caregiver's QoL Be Considered in Decisions About Whether a Patient Has an Experimental Double-Hand Transplant?

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