Hand Transplantation: The Innsbruck Experience
Hand transplantation is currently the most controversially discussed issue in the field of clinical transplantation. After the first hand of the “new era” was transplanted in Lyon in 1998, the debate on whether hand transplantation is justified or not resulted in numerous debates in the scientific press and the public media. Subjective conclusions and recommendations rather than a scientific evaluation of the current results have resulted in polarization between those pro and those contra hand transplantation. Initial fears that the transplanted limbs might be irreversibly rejected early after transplantation and that function would be poor were disproved. Instead, 100% graft survival at 1 year after hand transplantation is superior to the outcome achieved in any type of solid organ transplantation. However, the side effects related to the immunosuppressive treatment, the uncertain long-term outcome, the limited number of recipients meeting the required criteria together with the high cost of surgery, rehabilitation, and immunosuppression may be responsible for the decreased activity seen in this field in recent years.
KeywordsAcute Rejection Chronic Rejection Ulnar Artery Forearm Muscle Superficial Palmar Arch
Unable to display preview. Download preview PDF.
- 7.M. Lanzetta, P. Petruzzo, R. Margreiter, J. M. Dubernard, F. Schuind, W. Breidenbach, S. Lucchina, S. Schneeberger, C. van Holder, D. Granger, G. Pei, J. Zhao, X. Zhang, The international registry on hand and composite tissue transplantation, Transplantation 79(9), 1210–1214 (2005).PubMedCrossRefGoogle Scholar
- 10.G. Germann, Bilateral hand transplantation – indication and rationale, J Hand Surg [Br] 26, 521 (2001).Google Scholar
- 11.S. Schneeberger, B. Zelger, M. Ninkovic, R. Margreiter, Transplantation of the hand, Transplant Rev 100–107 (2005).Google Scholar
- 18.G. F. Salvini, C. C. Perfetti, A new method of rehabilitation of the hand in hemiplegic patients. (preliminary results) Riv Neurobial. 17(1), 11–20 (1971).Google Scholar
- 22.C. Brenneis, W. N. Loscher, K. E. Egger, T. Benke, M. Schocke, M. F. Gabl, G. Wechselberger, S. Felber, S. Pechlaner, R. Margreiter, H. Piza-Katzer, W. Poewe, Cortical motor activa-tion patterns following hand transplantation and replantation, J Hand Surg [Br] 30(5), 530–533 (2005).Google Scholar
- 25.M. R. Costanzo, D. C. Naftel, M. R. Pritzker, J. K. Heilman 3rd, J. P. Boehmer, S. C. Brozena, G. W. Dec, H. O. Ventura, J. K. Kirklin, R. C. Bourge, L. W. Miller, Heart transplant coronary artery disease detected by coronary angiography: a multiinstitutional study of preoperative donor and recipient risk factors. Cardiac Transplant Research Database, J Heart Lung Transplant 17, 744–753 (1998).PubMedGoogle Scholar
- 26.H. J. Eisen, E. M. Tuzcu, R. Dorent, J. Kobashigawa, D. Mancini, H. A. Valantine-von Kaeppler, R. C. Starling, K. Sorensen, M. Hummel, J. M. Lind, K. H. Abeywickrama, P. Bernhardt; RAD B253 Study Group, Everolimus for the prevention of allograft rejection and vasculopathy in cardiac-transplant recipients, N Engl J Med 349(9), 847–858 (2003).PubMedCrossRefGoogle Scholar
- 28.J. C. Ruiz, J. M. Campistol, J. M. Grinyo, A. Mota, D. Prats, J. A. Gutierrez, A. C. Henriques, J. R. Pinto, J. Garcia, J. M. Morales, J. M. Gomez, M. Arias, Early cyclosporine a withdrawal in kidney-transplant recipients receiving sirolimus prevents progression of chronic pathologic allograft lesions, Transplantation 78(9), 1312–1318 (2004).PubMedCrossRefGoogle Scholar
- 31.G. E. Koehl, J. Andrassy, M. Guba, S. Richter, A. Kroemer, M. N. Scherer, M. Steinbauer, C. Graeb, H. J. Schlitt, K. W. Jauch, E. K. Geissler, Rapamycin protects allografts from rejection while simultaneously attacking tumors in immunosuppressed mice, Transplantation 77(9), 1319–1326 (2004).PubMedCrossRefGoogle Scholar
- 32.M. Guba, P. von Breitenbuch, M. Steinbauer, G. Koehl, S. Flegel, M. Hornung, C. J. Bruns, C. Zuelke, S. Farkas, M. Anthuber, K. W. Jauch, E. K. Geissler, Rapamycin inhibits primary and metastatic tumor growth by antiangiogenesis: involvement of vascular endothelial growth factor, Nat Med 8(2), 128–135 (2002).PubMedCrossRefGoogle Scholar