• Palmina Petruzzo, Aram Gazarian, Jean Kanitakis, Helene Parmentier, Vincent Guigal, Michel Guillot, Christophe Vial, Jean Michel Dubernard, Emmanuel Morelon, and Lionel Badet.
• *Department of Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France †Department of Surgery, University of Cagliari, Cagliari, Italy ‡Chirurgie de la Main et du Membre Supérieur, Polyclinique Orthopédique de Lyon, Lyon, France §Department of Dermatology, Edouard Herriot Hospital, Lyon, France ¶Institut des Sciences et Techniques de la Réadaptation, Claude Bernard Lyon I University, Lyon, France ‖Rehabilitation Centre "Romans Ferrari," Miribel, France **Groupe Hospitalier Est, Hôpital neurologique, Centre de Référence en Pathologie Neuromusculaire Rhône-Alpes, Lyon, France ††Université de Lyon, Lyon, France.
• Ann. Surg.. 2015 Jan 1;261(1):213-20.

BackgroundThe clinic era of composite tissue allotransplantation was inaugurated by hand allotransplantation in 1998, giving rise to many controversies and scepticism because of the lifelong immunosuppression, the unclear risk-benefit ratio, and the uncertain long-term functional results of the procedure. The aim of this study was to evaluate the outcomes and the risk/benefit balance in bilateral hand allotransplantation.MethodsThe study included 5 cases of bilateral hand allotransplantation performed in a single center, with a follow-up ranging from 3 to 13 years. The recipients (4 men, 1 woman) were young. The level of amputation was distal in all cases except for 2 patients amputated at the midforearm level. All the recipients initially received the same immunosuppressive treatment that included tacrolimus, mycophenolate mofetil, prednisone, and, for induction, antithymocyte globulins.ResultsPatient and graft survival was 100%. All recipients showed adequate sensorimotor recovery (protective and tactile sensitivity and partial recovery of intrinsic muscles), they were able to perform the majority of activities of daily living, and had a normal social life. Most complications occurred in the first posttransplant year and were successfully managed. All recipients experienced at least 1 episode of acute rejection, which was easily reversed by increasing oral steroid dose or by intravenous steroids, except for patient 3, who presented 6 episodes of acute rejection, the latest 2 treated with Campath-1H.ConclusionsAlthough bilateral hand transplantation may be a satisfactory treatment option for amputees, a careful selection of candidates and a rigorous evaluation of recipients after transplantation are imperative.

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