OBJECTIVE: Objective of this study was to analyze fifteen months after surgery the sensorimotor recovery of the first human double hand transplantation. SUMMARY BACKGROUND DATA: As for any organ transplantation the success of composite tissue allografts such as a double hand allograft depends on prevention of rejection and its functional recovery. METHODS: The recipient was a 33-year-old man with bilateral amputation. Surgery included procurement of the upper extremities from a multiorgan cadaveric donor, preparation of the graft and recipient's stumps; then, bone fixation, arterial and venous anastomoses, nerve sutures, joining of tendons and muscles and skin closure. Rehabilitation program included physiotherapy, electrostimulation and occupational therapy. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil and, for induction, antithymocyte globulins and then CD25 monoclonal antibody were added. Sensorimotor recovery tests and functional magnetic resonance imaging (fMRI) were performed to assess functional return and cortical reorganization. All the results were classified according to Ipsen's classification. RESULTS: No surgical complications occurred. Two episodes of skin acute rejection characterized by maculopapular lesions were completely reversed increasing steroid dose within 10 days. By fifteen months the sensorimotor recovery was encouraging and the life quality improved. fMRI showed that cortical hand representation progressively shifted from lateral to medial region in the motor cortex. CONCLUSION: Even though at present this double hand allograft, treated using a conventional immunosuppression, allowed to obtain results at least as good as those achieved in replanted upper extremities, longer follow-up will be necessary to demonstrate the final functional restoration.
OBJECTIVE: Objective of this study was to analyze fifteen months after surgery the sensorimotor recovery of the first human double hand transplantation. SUMMARY BACKGROUND DATA: As for any organ transplantation the success of composite tissue allografts such as a double hand allograft depends on prevention of rejection and its functional recovery. METHODS: The recipient was a 33-year-old man with bilateral amputation. Surgery included procurement of the upper extremities from a multiorgan cadaveric donor, preparation of the graft and recipient's stumps; then, bone fixation, arterial and venous anastomoses, nerve sutures, joining of tendons and muscles and skin closure. Rehabilitation program included physiotherapy, electrostimulation and occupational therapy. Immunosuppressive protocol included tacrolimus, prednisone and mycophenolate mofetil and, for induction, antithymocyte globulins and then CD25 monoclonal antibody were added. Sensorimotor recovery tests and functional magnetic resonance imaging (fMRI) were performed to assess functional return and cortical reorganization. All the results were classified according to Ipsen's classification. RESULTS: No surgical complications occurred. Two episodes of skin acute rejection characterized by maculopapular lesions were completely reversed increasing steroid dose within 10 days. By fifteen months the sensorimotor recovery was encouraging and the life quality improved. fMRI showed that cortical hand representation progressively shifted from lateral to medial region in the motor cortex. CONCLUSION: Even though at present this double hand allograft, treated using a conventional immunosuppression, allowed to obtain results at least as good as those achieved in replanted upper extremities, longer follow-up will be necessary to demonstrate the final functional restoration.
Authors: C G Francois; W C Breidenbach; C Maldonado; T P Kakoulidis; A Hodges; J M Dubernard; E Owen; G Pei; X Ren; J H Barker Journal: Microsurgery Date: 2000 Impact factor: 2.425
Authors: J M Dubernard; E Owen; N Lefrançois; P Petruzzo; X Martin; M Dawahra; D Jullien; J Kanitakis; C Frances; X Preville; L Gebuhrer; N Hakim; M Lanzettà; H Kapila; G Herzberg; J P Revillard Journal: Transpl Int Date: 2000 Impact factor: 3.782
Authors: J W Jones; E T Ustüner; M Zdichavsky; J Edelstein; X Ren; C Maldonado; M Ray; A W Jevans; W C Breidenbach; S A Gruber; J H Barker Journal: Surgery Date: 1999-08 Impact factor: 3.982
Authors: E T Ustüner; M Zdichavsky; X Ren; J Edelstein; C Maldonado; M Ray; A W Jevans; W C Breidenbach; S A Gruber; J H Barker; J W Jones Journal: Transplantation Date: 1998-12-27 Impact factor: 4.939
Authors: Sebastian Giwa; Jedediah K Lewis; Luis Alvarez; Robert Langer; Alvin E Roth; George M Church; James F Markmann; David H Sachs; Anil Chandraker; Jason A Wertheim; Martine Rothblatt; Edward S Boyden; Elling Eidbo; W P Andrew Lee; Bohdan Pomahac; Gerald Brandacher; David M Weinstock; Gloria Elliott; David Nelson; Jason P Acker; Korkut Uygun; Boris Schmalz; Brad P Weegman; Alessandro Tocchio; Greg M Fahy; Kenneth B Storey; Boris Rubinsky; John Bischof; Janet A W Elliott; Teresa K Woodruff; G John Morris; Utkan Demirci; Kelvin G M Brockbank; Erik J Woods; Robert N Ben; John G Baust; Dayong Gao; Barry Fuller; Yoed Rabin; David C Kravitz; Michael J Taylor; Mehmet Toner Journal: Nat Biotechnol Date: 2017-06-07 Impact factor: 54.908
Authors: Ericka Bueno; Marie-Jose Benjamin; Geoffroy Sisk; Christian E Sampson; Matthew Carty; Julian J Pribaz; Bohdan Pomahac; Simon G Talbot Journal: Hand (N Y) Date: 2014-03