Successful forearm and hand transplantations from living donors: the first report

Forearm or hand transplantation from living donors has not previously been reported in the clinical literature. While its functional and ethical implications remain underexplored, carefully selected cases may present unique opportunities to significantly enhance recipients' quality of life.

This prospective clinical report describes two cases of successful limb transplantation from living donors. In Case 1, the right forearm of a 28-year-old male donor-rendered non-replantable proximally but with an intact distal segment-was temporarily heterotopically revascularized in the lower leg for 2 weeks before transplantation to a 31-year-old male recipient. In Case 2, a left hand from a 52-year-old male donor with an incomplete amputation was transplanted to a 31-year-old recipient. In both cases, all anatomical structures were reconstructed using microsurgical techniques. The immunosuppressive protocol included anti-thymocyte globulin, tacrolimus, mycophenolate mofetil, and methylprednisolone. Outcomes were evaluated through graft viability, immunologic response, and functional performance in activities of daily living.

Both grafts remained viable and functional at 18 and 36 months postoperatively. Mild rejection episodes were effectively managed with standard immunosuppression. Both patients resumed employment within 6 months and demonstrated satisfactory restoration of daily function.

This report confirms the clinical feasibility and functional efficacy of forearm and hand transplantation from living donors using intact remnants of non-replantable amputated limbs. This novel approach-previously unreported in the literature-may contribute to expanding the limited pool of grafts available for vascularized composite allotransplantation.