Hand transplantation: Lyon experience

Abstract

The first right hand and the first bilateral hand transplantation were performed in Lyon (France) on September 23, 1998 and on January 13, 2000, respectively; then a second bilateral hand transplantation was performed on April 30, 2003. These cases of hand transplantation demonstrated that it was possible to perform composite tissue allografts. The immunosuppressive protocol used for all French patients included an induction therapy (antithymocyte globulins, prednisone, tacrolimus, and mycophenolate mofetil) and a maintenance therapy (prednisone 5 mg/d, tacrolimus with blood levels between 5 and 10 ng/ml, and mycophenolate mofetil 2 g/d). The results achieved in the first case of hand allotransplantation showed the feasibility of the surgical technique, the efficacy of the immunosuppressive protocol, the limited adverse effects, and the importance of patient's compliance and rehabilitation to ensure graft viability and functional recovery. The recipient of the first single hand transplantation, a 48-year-old-man from New Zealand, whose right arm was accidentally amputated in 1984, received the hand from a 41-year-old brain-dead man. They presented the same blood group and several HLA mismatches, negative T- and B-cell cross-match. During the first months the patient presented a well-vascularized hand graft with normal skin and fast nerve regeneration which resulted in protective and useful sensation. He was able to perform the majority of daily activities (such as gripping a glass or writing) with his grafted right hand. At this time he presented a transient hyperglycemia and a Herpes virus infection as side effects of his immunosuppressive treatment, and 8 weeks after transplantation an acute rejection episode characterized by erythematous maculopapular lesions disseminated on the transplanted hand, which regressed increasing the oral dose of steroids and using topical immunosuppressants, such as tacrolimus and clobetasol creams.