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01 December 2009

Unsuccessful attempt of forearm transplantation – case report

Jerzy Jabłecki, Leszek Kaczmarzyk, Adam Domanasiewicz, Adam Chełmoński, Janusz Kaczmarzyk

Ann Transplant 2010; 15(1): 53-56 :: ID: 880569

Abstract

Background: The technique of hand transplantation is similar to that of hand replantation. Although the rate of failure of hand replantation tantamount to 15% on average, depending mostly on mechanism of amputation, until now no data have been published concerning the failure of attempts of hand transplantation.
Case Report: A 42-year-old male is presented who was the recipient of a hand transplant. The patient had an amputation of his left, dominant forearm (result of a circular- saw accident) 8 years prior to the transplantation. He was generally healthy, very dedicated to the operation. The limb was obtained in another hospital from a 49-year-old woman, victim of an accident and multi visceral donor.The donor was matched for blood group (0 positive), bone size, texture, with the recipient. There was 4 HLA antigen mismatch; the lymphocytotoxic cross-match was negative. The operation was performed in a sequence as follows : bones - muscles - nerves -veins -arteries - skin. The induction IT consisted of Simulect, Prograff, Cell-Cept,and steroids; the pharmacotherapy was standard as for a forearm replantation. The cold ischemia time was 9 hours. Soon after the transplantation the disturbances of blood circulation in the transplanted forearm were to be seen. High doses of macromolecular heparin were applied resulting in temporary improvement. During following hours despite various precautions the symptoms of ischemia of the hand up to 1/3 distal part of the forearm dramatically increased. The revision (performed 12 hrs after completing the transplantation) proved a massive thrombosis of hand arteries, and a large clot of the radial artery in locus of it's cannulation for invasive blood pressure measurement. The limb had to be re-amputated. As it came clear the arterial catheter was removed 6 hours prior to procurement.
Conclusions: The hand transplant are not free from non -immunological typical vascular complications. The arterial catheters should not be applied in limbs destined for procurement.

Keywords: Hand Transplantation, arterial thrombosis

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