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Selection of Candidates and Waiting List, Dealing with the Media and the Public, Setting Up a Pilot Study, Clinical Trial Organisation, Staff Requisites for Hand Transplantation: The Innsbruck Experience

  • Gerald Brandacher
  • Stefan Schneeberger
  • Raimund Margreiter

Abstract

Composite tissue allotransplantation (CTA) represents a therapeutic option after the loss of a hand, forearm or digits. Even if the level of immunosuppression seems to be comparable to that after pancreas, heart, or kidney transplantation, a high incidence of rejections and loss of two transplanted hands for immunological reasons have been observed so far [1]. Hand transplantation is a complex and multidisciplinary treatment and should only be considered in carefully selected patients. Not so much the risks of the surgical procedure but, rather, that of the associated long-term immunosuppression needs to be weighed against the expected benefits of such a transplant.

Keywords

Motor Imagery Chronic Rejection Immunosuppressive Protocol Recipient Selection Lymphoid Depletion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Lanzetta M, Petruzzo P, Margreiter R et al (2005) The International Registry on Hand and Composite Tissue Transplantation. Transplantation 79:1210–1214PubMedCrossRefGoogle Scholar
  2. 2.
    McCabe S, Rodocker G, Julliard K et al (1998) Using decision analysis to aid in the introduction of upper extremity transplantation. Transplant Proc 30:2783–2786PubMedCrossRefGoogle Scholar
  3. 3.
    Lees VC, McCabe SJ (2002) The rationale for hand transplantation. Transplantation 74:749–753PubMedCrossRefGoogle Scholar
  4. 4.
    Jones NF (2002) Concerns about human hand transplantation in the 21st century. J Hand Surg [Am] 27:771–787CrossRefGoogle Scholar
  5. 5.
    Dickenson D, Widdershoven G (2001) Ethical issues in limb transplants. Bioethics 15:110–124PubMedCrossRefGoogle Scholar
  6. 6.
    Petruzzo P, Badet L, Lanzetta M et al (2004) Concerns on clinical application of composite tissue allotransplantation. Acta Chir Belg 104:266–271PubMedGoogle Scholar
  7. 7.
    Lanzetta M, Petruzzo P, Vitale G et al (2004) Human hand transplantation: what have we learned? Transplant Proc 36:664–668PubMedCrossRefGoogle Scholar
  8. 8.
    Germann G (2001) Bilateral hand transplantation — indication and rationale. J Hand Surg [Br] 26:521Google Scholar
  9. 9.
    Moore FD (1970) Therapeutic innovation: ethical boundaries in the initial clinical trials of new drugs and surgical procedures. CA Cancer J Clin 20:212–227PubMedGoogle Scholar
  10. 10.
    Tobin GR, Breidenbach WC, Klapheke MM et al (2005) Ethical considerations in the early composite tissue allograft experience: a review of the Louisville Ethics Program. Transplant Proc 37:1392–1395PubMedCrossRefGoogle Scholar
  11. 11.
    Schneeberger S, Lucchina S, Lanzetta M et al (2005) Cytomegalovirus-related complications in human hand transplantation. Transplantation 80:441–447PubMedCrossRefGoogle Scholar
  12. 12.
    Islamov RR, Kiiasov AP (1994) Irreversible ischemic damages in the skeletal muscle of the severed extremity depending on the duration of the ischemia and the temperature. Morfologiia 106:145–150PubMedGoogle Scholar
  13. 13.
    Aravindan N, Williams MT, Riedel BJ et al (2005) Transcriptional responses of rat skeletal muscle following hypoxia-reoxygenation and near ischaemia-reperfusion. Acta Physiol Scand 183:367–377PubMedCrossRefGoogle Scholar
  14. 14.
    Blaisdell FW (2002) The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg 10:620–630PubMedCrossRefGoogle Scholar
  15. 15.
    Brunelli GA, Brunelli GR (1995) Tissue changes at different periods of ischemia. Int Angiol 14:253–263PubMedGoogle Scholar
  16. 16.
    Nanobashvili J, Neumayer C, Fugl A et al (2003) Ischemia/reperfusion injury of skeletal muscle: plasma taurine as a measure of tissue damage. Surgery 133:91–100PubMedCrossRefGoogle Scholar
  17. 17.
    Hettiaratchy S, Butler PE, Lee WP (2001) Lessons from hand transplantations. Lancet 357:494–495PubMedCrossRefGoogle Scholar
  18. 18.
    Siegler M (1998) Ethical issues in innovative surgery: should we attempt a cadaveric hand transplantation in a human subject? Transplant Proc 30:2779–2782PubMedCrossRefGoogle Scholar
  19. 19.
    Lee WP, Mathes DW (1999) Hand transplantation: pertinent data and future outlook. J Hand Surg [Am] 24:906–913CrossRefGoogle Scholar
  20. 20.
    Benatar D, Hudson DA (2002) A tale of two novel transplants not done: the ethics of limb allografts. BMJ 324:971–973PubMedCrossRefGoogle Scholar
  21. 21.
    Lanzetta M, Nolli R, Borgonovo A et al (2001) Hand transplantation: ethics, immunosuppression and indications. J Hand Surg [Br] 26:511–516Google Scholar
  22. 22.
    Agich GJ (2003) Extension of organ transplantation: some ethical considerations. Mt Sinai J Med 70:141–147PubMedGoogle Scholar
  23. 23.
    Petruzzo P, Revillard JP, Kanitakis J et al (2003) First human double hand transplantation: efficacy of a conventional immunosuppressive protocol. Clin Transplant 17:455–460PubMedCrossRefGoogle Scholar
  24. 24.
    Dubernard JM (2005) Composite tissue allografts: a challenge for transplantologists. Am J Transplant 5:1580–1581PubMedCrossRefGoogle Scholar
  25. 25.
    Schneeberger S, Zelger B, Ninkovic M et al (2005) Transplantation of the hand. Transplant Rev 19:100CrossRefGoogle Scholar
  26. 26.
    Reyes J, Mazariegos GV, Abu-Elmagd K et al (2005) Intestinal transplantation under tacrolimus monotherapy after perioperative lymphoid depletion with rabbit anti-thymocyte globulin (Thymoglobulin). Am J Transplant 5:1430–1436PubMedCrossRefGoogle Scholar
  27. 27.
    Shapiro R, Basu A, Tan H et al (2005) Kidney transplantation under minimal immunosuppression after pre-transplant lymphoid depletion with Thymoglobulin or Campath. J Am Coll Surg 200:505–515PubMedCrossRefGoogle Scholar
  28. 28.
    Oike F, Yokoi A, Nishimura E et al (2002) Complete withdrawal of immunosuppression in living donor liver transplantation. Transplant Proc 34:1521PubMedCrossRefGoogle Scholar
  29. 29.
    Watson CJ, Bradley JA, Friend PJ et al (2005) Alemtuzumab (CAMPATH 1H) Induction therapy in cadaveric kidney transplantation — efficacy and safety at five years. Am J Transplant 5:1347–1353PubMedCrossRefGoogle Scholar
  30. 30.
    Starzl TE (2005) Back to the future. Transplantation 79:1009–1014PubMedCrossRefGoogle Scholar
  31. 31.
    Wang MS, Zeleny-Pooley M, Gold BG (1997) Comparative dose-dependence study of FK506 and cyclosporin A on the rate of axonal regeneration in the rat sciatic nerve. J Pharmacol Exp Ther 282:1084–1093PubMedGoogle Scholar
  32. 32.
    Gold BG, Yew JY, Zeleny-Pooley M (1998) The immunosuppressant FK506 increases GAP-43 mRNA levels in axotomized sensory neurons. Neurosci Lett 241:25–28PubMedCrossRefGoogle Scholar
  33. 33.
    Margreiter R, Brandacher G, Ninkovic M et al (2002) A double-hand transplant can be worth the effort! Transplantation 74:85–90PubMedCrossRefGoogle Scholar
  34. 34.
    Schneeberger S, Ninkovic M, Piza-Katzer H et al (2006) Status 5 years after bilateral hand transplantation. Am J Transpl 4:834–841CrossRefGoogle Scholar
  35. 35.
    Jones JW, Gruber SA, Barker JH et al (2000) Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team. N Engl J Med 343:468–473PubMedCrossRefGoogle Scholar
  36. 36.
    Dubernard JM, Owen E, Herzberg G et al (1999) Human hand allograft: report on first 6 months. Lancet 353:1315–1320PubMedCrossRefGoogle Scholar
  37. 37.
    Dubernard JM, Petruzzo P, Lanzetta M et al (2003) Functional results of the first human double-hand transplantation. Ann Surg 238:128–136PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Gerald Brandacher
    • 1
  • Stefan Schneeberger
    • 1
  • Raimund Margreiter
    • 1
  1. 1.Department of General and Transplant SurgeryThe Medical UniversityInnsbruckAustria

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