Article
Update on The Innsbruck Hand Transplant Program More Than a Decade After the First Transplant
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Authors
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Annemarie Weißenbacher
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Gerhard Pierer
- Medizinische Universität Innsbruck, Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Innsbruck
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Markus Gabl
- Medizinische Universität Innsbruck, Universitätsklinik für Unfallchirurgie, Innsbruck
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Marina Ninkovic
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Theresa Hautz
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Bernhard Zelger
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Wolfgang Löscher
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Martin Kumnig
- Medizinische Universität Innsbruck, Universitätsklinik für Medizinische Psychologie, Medizinische Universität Innsbruck, Innsbruck
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Bettina Zelger
- Medizinische Universität Innsbruck, Department für Pathologie, Innsbruck
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Raimund Margreiter
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Gerald Brandacher
- Johns Hopkins University School of Medicine, Department of Plastic and Reconstructive Surgery, Baltimore
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Johann Pratschke
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
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Stefan Schneeberger
- Medizinische Universität Innsbruck, Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck
| Published: | April 26, 2013 |
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Outline
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Einleitung: We describe here the outcome after two bilateral hand, one bilateral forearm and one unilateral hand transplantation at 12, 9, 6 and 3 years after transplantation.
Material und Methoden: Four patients received a bilateral hand (n=2), a bilateral forearm (n=1) or a unilateral hand transplant between March 2000 and July 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, sirolimus/everolimus was added under simultaneous withdrawal (n=2) or dose reduction (n=1) of tacrolimus (n=1) or MMF (n=1). Steroids were avoided in one and withdrawn in two patients.
Ergebnisse: Total active range of motion improved continously with a grip strength of 2-10kg. 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 and a bullous pemphigoid. Three, six, four, and one rejection episode were successfully treated with steroids, anti-CD25, anti-CD52 antibodies and/or intensified maintenance IS. The second patient developed an DSA+ antibody mediated rejection 9 years after Tx, which was treated successfully with an CD20-Antibody. 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.
Schlussfolgerung: 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.
