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Hand and Upper Extremity Transplantation: An Update of Outcomes in the Worldwide Experience

Shores, Jaimie T. M.D.; Brandacher, Gerald M.D.; Lee, W. P. Andrew M.D.

Plastic and Reconstructive Surgery: February 2015 - Volume 135 - Issue 2 - p 351e–360e
doi: 10.1097/PRS.0000000000000892
Hand/Peripheral Nerve: Outcomes Article
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Background: Hand/upper extremity transplantation is the most common form of vascularized composite allotransplantation performed to date. An Update of worldwide outcomes is reported.

Methods: The authors summarize the international experience with 107 known transplanted hand/upper extremities in 72 patients. Data from published medical literature, national and international meetings, lay press reports, and personal communications were utilized to provide the most up-to-date summary.

Results: Although 24 losses (including four mortalities) are known, three of the four reported mortalities and eight of 24 limb losses were caused by multiple type vascularized composite allotransplantations (combined upper and lower limb or upper limb and face). Seven more losses were attributable to 15 patients in the early experience in China. In the United States and Western Europe, only three other non-acute graft losses have been reported, resulting in a patient survival rate for unilateral or bilateral hand transplantation in isolation of 98.5 percent and an overall graft survival rate of 83.1 percent.

Conclusions: Published functional outcomes continue to demonstrate improvement in function and quality of life. The international experience supports the idea that, for properly selected individuals, hand and upper extremity transplantation should be considered an important treatment option.

Baltimore, Md.

From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine

Received for publication March 18, 2014; accepted July 3, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Gerald Brandacher, M.D., 601 North Caroline Street, Johns Hopkins Outpatient Center, Suite 8140C, Baltimore, Md. 21287, gbranda2@jhmi.edu

©2015American Society of Plastic Surgeons