gms | German Medical Science

128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

The Innsbruck hand transplant program: Update at 10 years after the first transplant

Meeting Abstract

  • Annemarie Weißenbacher - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Gerhard Pierer - Medizinische Universität Innsbruck, Universitätsklinik für Plastische und Wiederherstellungschirurgie, Innsbruck
  • Markus Gabl - Medizinische Universität Innsbruck, Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Innsbruck
  • Marina Ninkovic - Klinikum Bogenhausen, MediCenter, München
  • Theresa Hautz - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Bettina Zelger - Medizinische Universität Innsbruck, Institut für Pathologie, Innsbruck
  • Wolfgang Löscher - Medizinische Universität Innsbruck, Universitätsklinik für Neurologie, Innsbruck
  • Michael Rieger - Medizinische Universität Innsbruck, Universitätsklinik für Radiologie, Innsbruck
  • Hildegunde Piza-Katzer - Medizinische Universität Innsbruck, Universitätsklinik für Plastische und Wiederherstellungschirurgie, Innsbruck
  • Raimund Margreiter - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Johann Pratschke - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Gerald Brandacher - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
  • Stefan Schneeberger - Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch465

DOI: 10.3205/11dgch465, URN: urn:nbn:de:0183-11dgch4650

Published: May 20, 2011

© 2011 Weißenbacher et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: We describe here the outcome after two bilateral hand, one bilateral forearm and one unilateral hand transplantation at 10/7/4 and 1 years after transplantation.

Materials and methods: Four patients received a bilateral hand (n=2), a bilateral forearm (n=1) or a unilateral hand transplant between March 2000 and June 2009. Induction therapy with ATG (n=2) or alemtuzumab (n=2) was followed by tacrolimus, prednisolon ± MMF (n=3) or tacrolimus and MMF (n=1) maintenance IS. Later, Prednisone was withdrawn (n=2) and sirolimus/everolimus was added to the therapeutic regime under simultaneous withdrawal (n=1) or dose reduction (n=1) of tacrolimus (n=1). MMF was discontinued in two patients. Steroids were entirely avoided in one and withdrawn in two patients.

Results: Range of motion reached up to 70% of normal with a grip strength of 2–10 kg. Hand function correlated well with time after transplant and amputation level. Intrinsic hand muscle function recovery and discriminative sensation were observed in all patients. Complications included CMV infection, fungal infection, hypertension, hyperglycemia, transient creatinine increase and headache. Three, six, four, and one rejection episode were successfully treated with steroids, anti-CD25, anti-CD52 antibodies and/or intensified maintenance IS. Skin histology at current shows no or mild perivascular lymphocytic infiltrates without signs of progression. Vessels are patent without signs for luminal narrowing or intimal proliferation.

Conclusion: The overall functional outcome and patient satisfaction after bilateral hand, bilateral forearm and unilateral hand transplantation are highly encouraging. All patients are now free of rejection with moderate levels of IS.