[Three lessons learned from the first double hand transplantation].

Area of Science:

• Reconstructive surgery
• Transplantation immunology
• Neuroplasticity

Background:

• Bilateral hand amputation presents significant functional and psychological challenges.
• Double hand transplantation is a complex reconstructive procedure with potential for restoring function.

Observation:

• The first double hand transplant recipient demonstrated satisfactory global and functional recovery at two years post-operation.
• Immunosuppressive therapy, including prednisone and steroid creams, was well-tolerated, with only two easily managed skin rejection episodes.
• Functional magnetic resonance imaging (fMRI) revealed significant cortical map remodeling and reversal of amputation-induced functional reorganization in the limb.

Findings:

• The immunosuppressive protocol was effective and well-tolerated, managing rejection episodes efficiently.
• Neuroimaging confirmed substantial neuroplastic changes, including the reversal of functional reorganization caused by amputation.
• Psychological adaptation to the transplanted hands, initially hindered by denial, improved as sensory and motor functions were regained.

Implications:

• This case highlights the feasibility and positive outcomes of double hand transplantation.
• Successful transplantation can lead to significant functional recovery and improved quality of life.
• Understanding and managing the psychological aspects, such as denial, are crucial for long-term transplant success.