[Composite allotransplantation in the upper extremity: from research to clinical reality]

Recent advancements in immunosuppression have made composite allotransplantation possible. To date, 38 hand allotransplantations have been performed in the world. Apart from the first case - amputated after voluntarily stopping the treatment- survival at 2-year follow-up has been 100%. After 2 years, 12 of the Chinese cases had to stop their treatment which led to complete loss of the transplanted parts. In 25 cases, results are known with a follow-up greater than 2 years. The transplanted patients all experienced one or more acute rejection episodes during the first postoperative year contrasting with only a 10% acute rejection rate following kidney transplantation. All these rejections were reversible with appropriate treatment. Extrinsic motor power was always restored, but intrinsic musculature only recovered in certain cases. Some sort of sensory discrimination was restored in 72% of the hands. All the patients had side effects related to immunosuppressive treatments, but none of these effects were life-threatening or impaired their quality of life. We think that composite allotransplantations should no longer be considered as clinical research and should be developed in accredited centres.