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Factors Influencing Acute Rejection of Human Hand Allografts: A Systematic Review

Bonastre, Jorge MD*; Landin, Luis MD, PhD*; Diez, Jesus MD, PhD; Casado-Sanchez, Cesar MD, PhD*; Casado-Perez, Cesar MD, PhD*

doi: 10.1097/SAP.0b013e318255a411
Transplantation Surgery and Research

Acute rejection (AR) of human hand allografts (HHAs) may carry a risk of graft loss and leads to the need for immunosuppressive treatment. The literature on HHAs was reviewed to determine and evaluate the factors that trigger AR of HHAs. Clinical case reports of hand allograft transplantation published between 1999 and 2011 in English, French, or German were reviewed systematically. The number of AR episodes was the main outcome measure. Sixty-eight episodes of AR were described in 28 recipients. Calcineurin inhibitor-based maintenance regimens were associated with significantly fewer AR episodes than non–calcineurin inhibitor-based regimens (mean 1.9 vs 3.2; P = 0.018). In recipients who experienced cytomegalovirus infection, the mean number of episodes of AR was 4, whereas in those who did not experience cytomegalovirus infection it was 2.25 (P = 0.024). The planning of hand allograft transplantation should take these factors into account to minimize the risk of AR.

From the *Division of Plastic and Reconstructive Surgery and †Biostatistics Section, University Hospital “La Paz,” Madrid, Spain.

Received November 7, 2011, and accepted for publication, after revision, March 14, 2012.

Dr Bonastre wrote the first draft and all the authors made their own contribution subsequently to the writing of the final manuscript; he also contributed to the data recovery and analysis. Dr Landin participated in the research design and data recovery and supervised the writing of the paper. Dr Diez participated in the data analysis and reviewing the paper. Dr Casado-Sánchez and Dr Casado-Pérez participated in reviewing the paper.

Conflicts of interest and sources of funding: none declared.

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.

Reprints: Luis Landin, MD, PhD, 28 Cabellera de Berenice St, 28023 Madrid, Spain. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.