Human hand allograft: report on first 6 months

Area of Science:

• Surgical Innovation
• Transplantation Medicine
• Immunology

Background:

• Advances in immunosuppression and limb replantation suggest clinical viability of human hand allotransplantation.
• Previous animal studies demonstrated long-term survival of limb allografts with novel immunosuppressant combinations.

Observation:

• A 48-year-old male received a right hand and distal forearm allograft from a 41-year-old brain-dead donor.
• The procedure involved complex microsurgical anastomoses, including bone fixation, vascular, and nerve sutures, with an ischemic time of 12.5 hours.
• Post-transplant immunosuppression utilized a combination of antithymocyte globulins, tacrolimus, mycophenolic acid, and prednisone.

Findings:

• The patient experienced an uneventful postoperative course with no surgical complications and good tolerance to immunosuppression.
• Mild cutaneous rejection signs at 8-9 weeks resolved with adjusted prednisone dosage and topical immunosuppressants.
• Significant progress in motor function through physiotherapy and excellent sensory recovery, with nerve regeneration reaching the wrist crease and palm within months.

Implications:

• Hand allotransplantation is a technically feasible procedure.
• Current immunosuppressive protocols appear effective in preventing acute rejection episodes.
• The functional outcome of hand allotransplantation may rival or exceed that of traditional autoreconstruction methods.