Live-donor nerve transplantation

Abstract

We recently reported the first case of live-donor nerve transplantation, performed in November 2000 in an 8-month-old infant with global obstetric brachial plexus palsy (OBPP) and four root avulsion who had undergone prior sural nerve autografting at 3 months. Cross-chest C7 nerve transfer and temporary tacrolimus (TCL)/prednisone immunosuppression were utilized. The purpose of this chapter is twofold. First, we provide the scientific rationale for our decision to develop the research protocol by reviewing the background information available at the time with regard to (1) the current treatment and long-term prognosis for infants with global OBPP; (2) use of the contralateral C7 nerve root as a donor site; (3) prior experimental and clinical experience with peripheral nerve allografting and clinical hand transplantation; and (4) experience with the use of immunosuppressants in pediatric solid-organ transplant recipients as well as in infants and young children receiving these drugs for nontransplant indications. Second, we present the case in detail and discuss the results obtained.