First forearm transplantation: Outcome at 3 years

S. Schneeberger, M. Ninkovic, M. Gabl, M. Ninkovic, H. Hussl, M. Rieger, W. Loescher, B. Zelger, G. Brandacher, H. Bonatti, T. Hautz, C. Boesmueller, H. Piza-Katzer, R. Margreiter

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


We here report on the surgical procedure, postoperative course and functional results at 3 years following the first bilateral forearm transplantation. A 41-year-old male underwent bilateral forearm transplantation on February 17, 2003. After ATG induction therapy, tacrolimus, prednisone and MMF were given for maintenance immunosuppression. At 16 months, MMF was switched to everolimus. Hand function, histology, immunohistochemistry, radiomorphology, motor and nerve conduction and somatosensory-evoked potentials were investigated at frequent intervals. A total of six rejection episodes required treatment with either steroids, basiliximab, ATG, alemtuzumab or tacrolimus dose augmentation. At 3 years, the patient is free of clinical signs of rejection despite a persisting minimal perivascular lymphocytic dermal infiltrate. No signs of myointimal proliferation in graft vessels were seen. Motor function continuously improved, resulting in satisfactory hand function. Intrinsic hand muscle function was first observed at 16 months and continues to improve. Although discrimination of hot and cold recovered, overall sensitivity remains poor. The patient is satisfied with the outcome. Bilateral forearm transplantation represents a novel therapeutic option after loss of forearms.

Original languageEnglish (US)
Pages (from-to)1753-1762
Number of pages10
JournalAmerican Journal of Transplantation
Issue number7
StatePublished - Jul 2007
Externally publishedYes


  • Composite tissue
  • Forearm
  • Hand transplantation
  • Outcome
  • Transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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