[A preliminary report of two cases of human hand allograft]

To study the feasibility of reconstruction of amputation by hand allograft in human being.

Two male recipients with traumatic right wrist amputation for 2 years, were matched respectively to two ABO- and Rh-compatible, HLA- half mpatible brain-dead donors. Direct crossmatch was performed to confirm the absence of prior sensitization to alloantigens. After amputation the donor's arm was irrigated with UW organ preservation solution at 4 degrees, and transported in a box with ice. One of the two donor arms was randomly selected and irradiated by 8 gy x-ray before transplantation. The transplantation involved radial and ulnar bone fixation, anastomoses of radial and ulnar artery, sutures of median and ulnar and radial nerves, joining of tendons except flexors digitorum superficialis, and skin closure. After surgery the patients were given wide-spectrum antibiotics, anticoagulation and antispasm agents, and immunosuppressants, which included antithymocyte globins, FK506, mycophenolic acid, prednisone systematically and fluocinolone acetonide ointment locally. Clinical observations included vital signs and circulation of the hands. Immune state was monitored by assaying C-reactive protein, Igs and PRA in the blood. Skin biopsy was done to exclude the dermal rejection. After the surgery the patients received psychotherapy and hand rehabilitation.

The circulation of the transplanted hands was similar to that of replanted ones. One of the patients developed hyperglycaemia, which required insulin administration. The skin healed naturally. The nerve regeneration were found more rapid by Tinel's sign. At 7 weeks erythema papulatum occurred on the skin, which was cured by withdrawing of fluocinolone acetonide ointment and application of calamine lotion. At 4 months the function of grafted hands recovered well, which could hold a drinking cup. The nerves had grown to the end of fingers and electromyograph showed regenerative action potentials of thenal muscles. Skin biopsy confirmed no rejection.

Ideal histocompatability and combined usage of currently available immunosupressants can prevent hyperacute and accelerating rejection of human hand allograft. The tissues heal and the early function recover similarly to those in autologous replantation.