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Presenter: Palmina, Petruzzo, Lyon, France
Authors: Palmina Petruzzo
Palmina Petruzzo, Hôpital Edouard Herriot, Lyon, France.
Background: The International Registry on Hand and Composite Tissue Transplantation includes hand and face allotransplantations.
Methods: From September 1998 forty-nine hands (17 unilateral and 16 bilateral hand transplantations, including one case of bilateral arm transplantation) have been reported, for a total of 33 patients. They were 31 males and 2 females, median age 32 years. In 46% of cases the level of amputation was at wrist.
From November 2005 eleven cases of face transplantations have been reported, 9 males and 2 females, median age 34 years. In the majority of cases the deficit included cheek, nose, chin, lips and perioral area. The patients presented impairment of swallowing, eating and speaking.
In hand and face transplantation the imunosuppressive therapy included tacrolimus, mycophenolate mofetil, sirolimus and steroids; polyclonal or monoclonal antibodies were used for induction. Follow-up ranges from 6 months to 11 years for hand transplantation and from 11 months to 5 years for face transplantation.
Results: One simultaneous face and bilateral hand transplantation died on day 65. Three patients transplanted in the Western countries have lost their grafted hands, and until September 2009 seven hand grafts were removed in China.
Eighty-five percent of hand and face recipients experienced at least one episode of acute rejection within the first post-transplant year that was reversible when promptly treated. Side-effects included opportunistic infections, metabolic complications and malignancies.
Hand-grafted patients developed protective sensibility, 90% of them tactile sensibility and 82.3% also a discriminative sensibility Motor recovery enabled patients to perform most daily activities. Face-grafted patients improved their aesthetic aspect and particularly some activities such as eating, drinking and speaking, living a normal social life.
Conclusions: Hand and face transplantations are successful procedures, however careful evaluation of patients before and after transplantation and their compliance are indispensable.
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