Successful hand transplantation - One-year follow-up

Background: On the basis of positive results in studies of the transplantat ion of pig extremities and the information exchanged at an international sy mposium on composite-tissue transplantation, we developed a protocol for hu man hand transplantation. Methods: After a comprehensive pretransplantation evaluation and informed-c onsent process, the left hand of a 58-year-old cadaveric donor, matched for size, sex, and skin tone, was transplanted to a 37-year-old man who had lo st his dominant left hand 13 years earlier. Immunosuppression consisted of basiliximab for induction therapy and tacrolimus, mycophenolate mofetil, an d prednisone for maintenance therapy. Results: The cold-ischemia time of the donor hand was 310 minutes. There we re no intraoperative or early postoperative complications. Moderate acute c ellular rejection of the skin of the graft developed 6, 20, and 27 weeks af ter transplantation. All three episodes resolved completely after treatment with intravenous methylprednisolone and topical tacrolimus and clobetasol. Temperature, pain, and pressure sensation had developed in the hand and fi ngers by one year. At one year, the patient could perform many functional a ctivities with his left hand that he had not been able to perform with his prosthesis, such as throwing a baseball, turning the pages of a newspaper, writing, and tying his shoelaces. Conclusions: Early success has been achieved in hand transplantation with t he use of currently available immunosuppressive drugs. (N Engl J Med 2000;3 43:468-73.) (C)2000, Massachusetts Medical Society.