A double-hand transplant can be worth the effort!

Area of Science:

• Composite-tissue transplantation
• Limb reconstruction surgery
• Immunosuppression protocols

Background:

• Composite-tissue transplantation is a potential therapeutic option for patients experiencing hand loss.
• Long-term outcomes regarding graft function and immunosuppression side effects after hand transplantation remain under-investigated.
• This study reports on the outcomes of a double-hand transplant performed over 18 months prior.

Observation:

• A 47-year-old male received a double-hand transplant 6 years after losing both hands.
• The patient underwent induction therapy with antithymocyte globulin and maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and prednisone.
• Prophylactic ganciclovir and co-trimoxazole were administered; a specialized cognitive-based rehabilitation program was implemented for 1 year.

Findings:

• The transplant resulted in minor early skin necrosis and arteriovenous fistulas requiring ligation.
• One acute rejection episode occurred but resolved with high-dose steroids and topical tacrolimus.
• Despite prophylaxis, cytomegalovirus (CMV) replication occurred, necessitating additional treatment with foscarnet and cidofovir.
• At 18 months post-transplant, graft motility reached 60% of normal function, significantly improving the patient's capabilities compared to myoelectric prostheses.

Implications:

• Excellent long-term results are achievable with double-hand transplantation.
• Successful outcomes depend on meticulous surgical technique, precise immunosuppression management, and comprehensive rehabilitation.
• This case highlights the potential of hand transplantation to restore significant function and improve quality of life for individuals with severe hand loss.