Long-term outcome after hand and forearm transplantation – a retrospective study

Theresa Hautz, Franka Messner, Annemarie Weissenbacher, Hubert Hackl, Martin Kumnig, Marina Ninkovic, Valeria Berchtold, Johanna Krapf, Bettina G. Zelger, Bernhard Zelger, Dolores Wolfram, Gerhard Pierer, Wolfgang N. Löscher, Robert Zimmermann, Markus Gabl, Rohit Arora, Gerald Brandacher, Raimund Margreiter, Dietmar Öfner, Stefan Schneeberger

Research output: Contribution to journalArticlepeer-review

Abstract

Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long-term results at 20 years. During the 6–20 years follow-up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody-related with serum donor-specific alloantibodies (DSA) and skin-infiltrating B-cells. The cell phenotype in rejecting skin biopsies changed and C4d-staining increased with time post-transplantation. In the long-term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well-being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection-free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA.

Original languageEnglish (US)
Pages (from-to)1762-1778
Number of pages17
JournalTransplant International
Volume33
Issue number12
DOIs
StatePublished - Dec 2020

Keywords

  • complications
  • donor-specific antibodies
  • hand and forearm transplantation
  • immunosuppression
  • rejection
  • vascularized composite allotransplantation

ASJC Scopus subject areas

  • Transplantation

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