Transplantation Surgery and ResearchPerioperative Ischemic Injury and Fibrotic Degeneration of Muscle in a Forearm Allograft: Functional Follow-up at 32 Months Post TransplantationLandin, Luis MD*; Cavadas, Pedro C. MD, PhD*; Garcia-Cosmes, Pedro MD, PhD†; Thione, Alessandro MD, PhD*; Vera-Sempere, Francisco MD, PhD‡Author Information From the *Division of Transplant Surgery, University Hospital “La Fe,” Valencia, Spain; †Division of Nephrology, University Hospital, Salamanca, Spain; and ‡Division of Pathology, University Hospital “La Fe,” Valencia, Spain. Received July 30, 2010, and accepted for publication, after revision, November 13, 2010. A CTA transplant program was approved at our institution by the Institutional Review Board and by the Spanish Organización Nacional de Transplantes (ONT). There are no sources of support that require acknowledgment. The authors have no financial or personal relationships with other people or organizations that could influence (bias) this work inappropriately. The authors have no financial interest in any of the drugs mentioned in this work. Alemtuzumab, tacrolimus, sirolimus, and mycophenolate mofetil were used off-label to prevent and treat rejection of hand allografts. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsplasticsurgery.com). Reprints: Luis Landin, MD, Clinica Cavadas, Paseo de Facultades 1, bajo 8, 46021 Valencia, Spain. E-mail: [email protected]. Annals of Plastic Surgery: February 2011 - Volume 66 - Issue 2 - p 202-209 doi: 10.1097/SAP.0b013e318206a365 Buy SDC Metrics AbstractIn Brief Allografts of the forearm are still uncommon in the field of composite tissue allograft transplantation. In November 2007, a right-hand allograft and a left-hand/full-length forearm allograft were transplanted in a 30-year-old man who lost both hands and the vision in his left eye due to an explosion. The patient underwent alemtuzumab and steroid induction therapy. Tacrolimus, mycophenolate mofetil, and low doses of steroids were given to prevent rejection. The allografts were rejected 3 times, but these episodes were controlled successfully. The immunosuppressive regimen was switched from tacrolimus to sirolimus because of increased serum creatinine. The left allograft showed a flexion contracture due to muscle fibrosis that was conjectured to be associated with a perioperative ischemic injury and permitted only a Moberg-type key pinch. In contrast, an excellent grade of function was observed in the right allograft. The Disabilities of the Shoulder, Arm, and Hand score improved from 70.83 to 36.6 and intrinsic musculature returned to both allografts. The patient was able to work 2 years after transplantation. This is the first report of an ischemic injury related to the successful allotransplantation of a composite tissue. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT. © 2011 Lippincott Williams & Wilkins, Inc.