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Functional Results of the First Human Double-Hand Transplantation

Dubernard, Jean Michel MD, PhD*; Petruzzo, Palmina MD; Lanzetta, Marco MD; Parmentier, Helen PT, CHT§; Martin, Xavier MD*; Dawahra, Marwan MD*; Hakim, Nadey S MD, PhD; Owen, Earl MD

doi: 10.1097/01.SLA.0000078945.70869.82
Original Articles

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.

The first double-hand allografts showed that encouraging sensorimotor recovery is possible by using conven-tional immunosuppression. Nerve regeneration, sensitive protection and cortical reorganization were demon-strated. The rehabilitation program was shown to be of paramount importance in the final result of this transplantation.

From the *Service de Chirurgie de Transplantation Hopital Edouard Herriot, Lyon, France;

†Department of Surgery and Transplantation, University of Cagliari, Italy;

‡Hand Surgery and Reconstructive Microsurgery, San Gerardo Hospital, Monza—University Milan Bicocca, Italy;

§Service d'Orthopédie et de Chirurgie du Membre Supérieur Hopital Edouard Herriot, Lyon, France;

¶Transplantation Unit, St Mary's Hopital, London, United Kingdom;

∥Microsearch Foundation of Australia and Outer Sydney Hand and Microsurgery Unit, Sydney, Australia.

Reprints: Jean Michel Dubernard, Service d'Urologie et de Transplantation, Hopital Edouard Herriot, Place d'Arsonval, 69347 Lyon, France. E-mail: jean-michel.dubernard@chu-lyon.fr.

© 2003 Lippincott Williams & Wilkins, Inc.