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Long‐term outcome after hand and forearm transplantation – a retrospective study

Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long‐term results at 20 years. During the 6–20 years follow‐up, 43 rejection...

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Autores principales: Hautz, Theresa, Messner, Franka, Weissenbacher, Annemarie, Hackl, Hubert, Kumnig, Martin, Ninkovic, Marina, Berchtold, Valeria, Krapf, Johanna, Zelger, Bettina G., Zelger, Bernhard, Wolfram, Dolores, Pierer, Gerhard, Löscher, Wolfgang N., Zimmermann, Robert, Gabl, Markus, Arora, Rohit, Brandacher, Gerald, Margreiter, Raimund, Öfner, Dietmar, Schneeberger, Stefan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756600/
https://www.ncbi.nlm.nih.gov/pubmed/32970891
http://dx.doi.org/10.1111/tri.13752
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author Hautz, Theresa
Messner, Franka
Weissenbacher, Annemarie
Hackl, Hubert
Kumnig, Martin
Ninkovic, Marina
Berchtold, Valeria
Krapf, Johanna
Zelger, Bettina G.
Zelger, Bernhard
Wolfram, Dolores
Pierer, Gerhard
Löscher, Wolfgang N.
Zimmermann, Robert
Gabl, Markus
Arora, Rohit
Brandacher, Gerald
Margreiter, Raimund
Öfner, Dietmar
Schneeberger, Stefan
author_facet Hautz, Theresa
Messner, Franka
Weissenbacher, Annemarie
Hackl, Hubert
Kumnig, Martin
Ninkovic, Marina
Berchtold, Valeria
Krapf, Johanna
Zelger, Bettina G.
Zelger, Bernhard
Wolfram, Dolores
Pierer, Gerhard
Löscher, Wolfgang N.
Zimmermann, Robert
Gabl, Markus
Arora, Rohit
Brandacher, Gerald
Margreiter, Raimund
Öfner, Dietmar
Schneeberger, Stefan
author_sort Hautz, Theresa
collection PubMed
description Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long‐term results at 20 years. During the 6–20 years follow‐up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody‐related with serum donor‐specific alloantibodies (DSA) and skin‐infiltrating B‐cells. The cell phenotype in rejecting skin biopsies changed and C4d‐staining increased with time post‐transplantation. In the long‐term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well‐being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection‐free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA.
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spelling pubmed-77566002020-12-28 Long‐term outcome after hand and forearm transplantation – a retrospective study Hautz, Theresa Messner, Franka Weissenbacher, Annemarie Hackl, Hubert Kumnig, Martin Ninkovic, Marina Berchtold, Valeria Krapf, Johanna Zelger, Bettina G. Zelger, Bernhard Wolfram, Dolores Pierer, Gerhard Löscher, Wolfgang N. Zimmermann, Robert Gabl, Markus Arora, Rohit Brandacher, Gerald Margreiter, Raimund Öfner, Dietmar Schneeberger, Stefan Transpl Int Original Articles Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long‐term results at 20 years. During the 6–20 years follow‐up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody‐related with serum donor‐specific alloantibodies (DSA) and skin‐infiltrating B‐cells. The cell phenotype in rejecting skin biopsies changed and C4d‐staining increased with time post‐transplantation. In the long‐term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well‐being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection‐free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA. John Wiley and Sons Inc. 2020-11-10 2020-12 /pmc/articles/PMC7756600/ /pubmed/32970891 http://dx.doi.org/10.1111/tri.13752 Text en © 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Hautz, Theresa
Messner, Franka
Weissenbacher, Annemarie
Hackl, Hubert
Kumnig, Martin
Ninkovic, Marina
Berchtold, Valeria
Krapf, Johanna
Zelger, Bettina G.
Zelger, Bernhard
Wolfram, Dolores
Pierer, Gerhard
Löscher, Wolfgang N.
Zimmermann, Robert
Gabl, Markus
Arora, Rohit
Brandacher, Gerald
Margreiter, Raimund
Öfner, Dietmar
Schneeberger, Stefan
Long‐term outcome after hand and forearm transplantation – a retrospective study
title Long‐term outcome after hand and forearm transplantation – a retrospective study
title_full Long‐term outcome after hand and forearm transplantation – a retrospective study
title_fullStr Long‐term outcome after hand and forearm transplantation – a retrospective study
title_full_unstemmed Long‐term outcome after hand and forearm transplantation – a retrospective study
title_short Long‐term outcome after hand and forearm transplantation – a retrospective study
title_sort long‐term outcome after hand and forearm transplantation – a retrospective study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756600/
https://www.ncbi.nlm.nih.gov/pubmed/32970891
http://dx.doi.org/10.1111/tri.13752
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