Human hand transplantation: what have we learned?

Area of Science:

• Reconstructive surgery
• Transplantation immunology
• Limb functional restoration

Background:

• Hand transplantation is an emerging procedure for restoring upper limb function.
• Existing prostheses have limitations in functional restoration.
• Limited clinical data exists on hand transplantation outcomes.

Purpose of the Study:

• To report the combined French and Italian experience in hand transplantation.
• To evaluate functional outcomes and complications in a series of hand transplant patients.
• To assess the efficacy of a specific immunosuppressive protocol.

Main Methods:

• A retrospective analysis of six patients (eight hands) undergoing hand transplantation.
• Utilized a jointly devised protocol for transplantation and immunosuppression.
• Monitored rejection using distant sentinel skin grafts and standard clinical assessments.

Main Results:

• No surgical complications were reported.
• All patients experienced skin rejection, with a mean onset of 40 days post-transplantation.
• Three patients regained protective and some discriminative sensation; two are in early recovery phases.
• One patient experienced uncontrolled rejection and reamputation due to non-compliance with immunosuppression.

Conclusions:

• Hand transplantation demonstrates promising functional restoration, exceeding prosthesis capabilities.
• Effective immunosuppression management is critical for long-term graft survival and function.
• Sentinel skin grafts can aid in monitoring rejection in hand transplant recipients.