Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review.
Hand allograft transplantation (HAT) refers to the grafting of a donor hand onto another person's forearm including; bone, artery, tendon, nerve and vein. More than 50 of these operations have been performed worldwide. Alongside the need for long term use of immunosuppresive (IS) drugs, the adoption of HAT has been stunted by limited evidence of improvement in upper limb function.
This paper retrospectively reviewed 28 HATs, looking at outcome measures including; DASH (Disabilities of the arm, shoulder and hand) and HTSS (hand transplant score system.) In 57% of the reviewed cases the intrinsic muscle function was observed post transplant, indicating good quality neural repair within a short time frame.
The review confirmed a significant improvement in upper limb functionality, with possible implication that bilateral allografts gain more functionality than unilateral (although inconclusive.) Significantly there were 52 complications noted within this group of 28 recipients, due to use of IS. It was also noted that the time between amputation and transplant did not show influence on function recovery, with one case stating a 28 year gap.
The authors indicate that the lack of a control group limits the study, concluding that HAT should be offered only to selected candidates as, although there is functional gain, the associated risk of complication due to chronic IS therapy is high. > From: Landin et al., Transpl Int, 25 (2012) 424-432. All rights reserved to European Society for Organ Transplantation.
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See the story, and operation, of a young woman who receives a hand allograft in the YouTube clip below.