The Innsbruck hand transplant program: update at 8 years after the first transplant

Area of Science:

• Transplantation immunology
• Reconstructive surgery
• Vascularized composite allotransplantation

Background:

• Updates on long-term outcomes of bilateral hand and forearm transplantation are crucial for understanding graft survival and function.
• Immunosuppression (IS) protocols are key to preventing rejection in these complex procedures.

Observation:

• Three patients underwent bilateral hand or forearm transplantation between 2000 and 2006.
• Patients received induction therapy followed by maintenance IS, with some later switching to sirolimus/everolimus.
• Regular clinical follow-ups included functional, morphological, and vascular assessments.

Findings:

• Good functional recovery was observed, with continuous improvement in hand function for 3 years, followed by stabilization.
• No signs of graft vascular occlusion or stenosis were detected via angiography and other imaging.
• All patients achieved protective sensation, but discriminative sensation was limited to hand transplants.

Implications:

• Moderate immunosuppression levels can be maintained long-term without chronic rejection in hand and forearm transplant recipients.
• Vascularized composite allotransplantation of the upper extremities can yield good functional results and graft survival.
• Further research into optimizing IS protocols and sensory recovery is warranted.