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21 May 2009

Polish program of hand transplantation (HTx) – 4 years of experience

J Jabłecki, D Patrzałek, L Kaczmarzyk, A Chełmoński, A Domanasiewicz, M Boratyńska

Ann Transplant 2009; 14(1): 14-15 :: ID: 880246

Abstract

Background: Living with any type of defi cit or deformity has become increasingly difficult in our modern societies, which value appearance, which reflects on our emotional, physical and social wellbeing. Health is found to be grounded in a sense of self and a sense of body, both of which are tied to conceptions of past and future actions. It seems as if there is no place for less than perfect people, hence the obsessions with fi tness, body image, and in general with the way we appear to others. No doubt we should consider transplantation nowadays not only to prolong or to save life, but also to improve quality of life. Until the February 2009 43 upper limbs have been transplanted on different levels of previously done amputation, in many centers all over the world (transplantations performed in Peoples Republic of China are excluded from the registry). Only two transplantations failed, whereas the rest of the patients are doing well, presenting no serious complications . It was proved that the generally achieved functional result of these patients is better then that of equivalent replantations. The hand transplantations are performed in specialized centers proceeding with the board-accepted transplantation program. In Poland such requirements fulfills The Subdepartment or Replantation of Limbs of St Jadwiga Hosp. in Trzebnica. The goal of this study is the presentation of the experience of the Center after three years of activity.
Material/Methods: Creating the "waitng list of would-be hand recipients" we  adhered the following inclusion criteria: age comprised between 18 and 50 years, dominant hand or bilateral upper limbs after traumatic amputation at any level below mid-arm, tried and refused different prosthetic alternatives, otherwise healthy and mentally sane, able to give an informed consent, resident in the country, available to follow-up, with the support of his/her family and local medical practitioners. A total number of 52 possible candidates were seen over a 4 years period, and according to the selection process and inclusion criteria 13 patients were thought to be preliminary candidates for a HTx. These 13 patients proceeded to a formal hospital admission after signing the detailed informed consent, in order to sustain a detailed evaluation including invasive diagnostic tests (i.e. full blood tests, MRI, psychology tests, muscle and sensory evaluation, ultrasound, HIV and HCV tests). These group consist of 12 M (aged 21-42) with single, dominant had amputation and one female (aged 23) with both hands amputation. Within this group 3 HTx were performed in 3 men aged 32, 42, 30 in the years: 2006, 2007 (mid-forearm level), and in 2008 (distal forearm level). The laps of time from amputation to HTx was 14, 6, and 7 years respectively.The surgical technique was similar to that commonly used for replantation, as was the basic for rehabilitation process. The IT -protocol was based on Simulect (induction), Prograf, Cell-Cept, steroids. The doses of IT were modified according to the patients status (average Prograf serum level in both successful recipients ranged from 10 to 15 ng/ml)
Results: The follow-up of our first patient is close to 3 years now. He is extremely satisfied with his hand which he totally incorporated to his body image, total motion of fingers (TAM) equals 63% of his unaffected hand, the evaluation by SF 36 protocol gave the result -50, by DASH - 95, by CFSS (acc. to Lanzetta, Petruzzo) - 84 points (excellent). The patient came back to work on the 20th month after the transplantation. He had only one episode of minor rejection. Our second HTx failed. Massive thrombosis evoked by an arterial blood -pressure device removed only 2 days before HTx resulted in an amputation on the first post op. day . The third patient, whose follow -up is 6 months only has a very good hand function (finger motion 80% of an unaffected hand) and sensitivity reaching his finger tips. No rejection episodes were observed.
Conclusions: On the basis of the already achieved results we assume that we should proceed with the hand transplantation program.

Keywords: Hand Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358