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Arm and Hand Transplant

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73 papers 25 to 100 followers Includes upper limb and hand vascularized composite allotransplantation
By Mafer Amber QxMD ambassador, Mexican med student currently in 4° year, doing clinical research in vascularized composite allotransplantation
https://www.readbyqxmd.com/read/21554424/achievements-and-challenges-in-composite-tissue-allotransplantation
#1
REVIEW
Stefan Schneeberger, Luis Landin, Jerzy Jableki, Peter Butler, Christoph Hoehnke, Gerald Brandacher, Emmanuel Morelon
Overall, more than 60 hand/forearm/arm transplantations and 16 face transplantations have been performed in the past 12 years. In the European experience summarized here, three grafts have been lost in response to a vascular thrombosis (n = 1), rejection and incompliance with immunosuppression (n = 1) and death (n = 1). The overall functional and esthetic outcome is very satisfactory, but serious side effects and complications related to immunosuppression are challenges hindering progress in this field. The high levels of immunosuppression, skin rejection, nerve regeneration, donor legislation and the acceptance level need to be addressed to promote growth of this promising new field in transplantation and reconstructive surgery...
August 2011: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/23001085/upper-extremity-transplantation-using-a-cell-based-protocol-to-minimize-immunosuppression
#2
Stefan Schneeberger, Vijay S Gorantla, Gerald Brandacher, Adriana Zeevi, Anthony J Demetris, John G Lunz, Diana M Metes, Albert D Donnenberg, Jaimie T Shores, Andrea F Dimartini, Joseph E Kiss, Joseph E Imbriglia, Kodi Azari, Robert J Goitz, Ernest K Manders, Vu T Nguyen, Damon S Cooney, Galen S Wachtman, Jonathan D Keith, Derek R Fletcher, Camila Macedo, Raymond Planinsic, Joseph E Losee, Ron Shapiro, Thomas E Starzl, W P Andrew Lee
OBJECTIVE: To minimize maintenance immunosuppression in upper-extremity transplantation to favor the risk-benefit balance of this procedure. BACKGROUND: Despite favorable outcomes, broad clinical application of reconstructive transplantation is limited by the risks and side effects of multidrug immunosuppression. We present our experience with upper-extremity transplantation under a novel, donor bone marrow (BM) cell-based treatment protocol ("Pittsburgh protocol")...
February 2013: Annals of Surgery
https://www.readbyqxmd.com/read/28804740/avascular-necrosis-of-the-humeral-head-following-bilateral-upper-extremity-vascular-composite-allotransplantation-a-case-report
#3
Jacob Rinkinen, David Molway, Matthew Carty, George S M Dyer, Bohdan Pomahac, Anil Chandraker, Simon G Talbot
Vascularised composite allotransplantation (VCA) represents an exciting and emerging field in plastic and reconstructive surgery. Despite the generally good functional and psychosocial outcomes, multiple complications can be associated with the procedure. The authors describe a case of avascular necrosis of the humeral head following successful upper extremity VCA.
2017: Case Reports in Plastic Surgery & Hand Surgery
https://www.readbyqxmd.com/read/28742936/benefits-and-limitations-of-belatacept-in-4-hand-transplanted-patients
#4
J Grahammer, A Weissenbacher, B G Zelger, B Zelger, C Boesmueller, M Ninkovic, A Mühlbacher, I Peschel, G Brandacher, D Öfner, S Schneeberger
Belatacept (CTLA4Ig) is an emerging treatment in kidney transplantation. Lack of nephrotoxicity and possibly an inhibitory effect on the development of donor specific antibodies (DSA) make it an interesting agent in hand transplantation. In order to reduce CNI immunosuppression and preserve kidney function, we have added belatacept to the therapeutic regimen of 4 hand transplanted patients at month 4, at 6, 9, and 13 years after hand/forearm transplantation. Patients received 5mg/kg belatacept every 2 weeks, the dosing interval was extended to 4 weeks after 5 applications...
July 25, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28719391/pediatric-and-congenital-hand-transplantation
#5
Sandra Amaral, L Scott Levin
PURPOSE OF REVIEW: We review the approach and challenges associated with pediatric hand transplantation, including new knowledge gleaned from our recent case of bilateral hand-forearm transplantation in an 8-year old child. RECENT FINDINGS: Bilateral heterologous hand-forearm transplantation was performed in a child with a prior kidney transplant in July 2015. The initial surgery necessitated a large team of experts in microvascular surgery, transplant surgery, orthopedics and plastic surgery as well as pediatric anesthesia...
July 14, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28654973/erosive-rheumatoid-arthritis-after-bilateral-hand-transplantation
#6
Brittany L Adler, Jemima Albayda, Jamie T Shores, W P Andrew Lee, Gerald Brandacher, Clifton O Bingham
No abstract text is available yet for this article.
August 1, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28361279/outcomes-after-hand-and-upper-extremity-transplantation
#7
REVIEW
Jaimie T Shores, Veronika Malek, W P Andrew Lee, Gerald Brandacher
Hand and upper extremity transplantation (HUET) has emerged as the most frequently performed reconstructive procedure in the burgeoning field of vascularized composite allotransplantation (VCA). VCA refers to a form of transplant with multiple tissue types that represents a viable treatment option for devastating injuries where conventional reconstruction would be unable to restore form and function. As hand transplantation becomes increasingly more common, discussions on advantages and disadvantages of the procedure seem to intensify...
May 2017: Journal of Materials Science. Materials in Medicine
https://www.readbyqxmd.com/read/26579339/psychosocial-outcomes-after-bilateral-hand-transplantation
#8
Mansher Singh, Megan Oser, Jennifer Zinser, Geoffroy Sisk, Matthew J Carty, Christian Sampson, Julian J Pribaz, Bohdan Pomahac, Simon G Talbot
UNLABELLED: Since the first successful hand transplantation in 1998, there have been multiple reports about surgical technique, transplant survival, and immunosuppression. However, very limited published data exist on psychosocial outcomes following hand transplantation. METHODS: We report psychosocial outcomes in a patient with bilateral hand transplants at the midforearm level with serial follow-ups over 3.5 years. Different metrics used to study psychosocial outcomes included the following: SF-12, CES-D, Dyadic Adjustment Scale, Rosenberg SE, and EQ-5D...
October 2015: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/24570631/rehabilitation-following-hand-transplantation
#9
Ericka Bueno, Marie-Jose Benjamin, Geoffroy Sisk, Christian E Sampson, Matthew Carty, Julian J Pribaz, Bohdan Pomahac, Simon G Talbot
BACKGROUND: Hand allotransplantation can restore motor, sensory and cosmetic functions to upper extremity amputees. Over 70 hand transplant operations have been performed worldwide, but there is little published regarding post-hand transplant rehabilitation. METHODS: The Brigham and Women's Hospital (BWH) Hand Transplantation Team's post-hand transplant rehabilitation protocol is presented here. The protocol must be modified to address each transplant recipient's unique needs...
March 2014: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/19741477/preliminary-results-of-bilateral-arm-transplantation
#10
LETTER
Luis Landin, Pedro C Cavadas, Peter Nthumba, Javier Ibañez, Francisco Vera-Sempere
No abstract text is available yet for this article.
September 15, 2009: Transplantation
https://www.readbyqxmd.com/read/28538571/angiosome-based-allografts-vascularized-composite-allotransplantation-for-tailored-subunit-reconstruction-with-volkmann-ischemic-contracture-as-a-case-in-point
#11
G Ian Taylor, David S Sparks, Adam C Gascoigne, Russell J Corlett, Mark W Ashton
BACKGROUND: As we enter an age with new approaches to tissue reconstruction, the emphasis on the adage "like for like" has become even more relevant. This study illustrates the potential for several tailored vascularized composite allotransplantation reconstructive techniques and, in particular, for the management of Volkmann contracture. METHODS: Twenty fresh cadaver dissections and 30 archival lead oxide radiographic studies were examined to (1) identify potential upper limb vascularized composite allotransplantation donor sites (i...
June 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28390109/vascularized-composite-allograft-vca-donation-and-transplantation-a-survey-of-public-attitudes-in-the-united-states
#12
James R Rodrigue, David Tomich, Aaron Fleishman, Alexandra K Glazier
Vascularized composite allograft (VCA) transplantation has emerged as a groundbreaking surgical intervention to return identity and function following traumatic injury, congenital deformity, or disfigurement. While public attitudes toward traditional organ/tissue donation are favorable, little is known about attitudes toward VCA donation and transplantation. A survey was conducted of 1,485 U.S. residents in August 2016 to assess VCA donation attitudes. Participants also completed the Revised Health Care System Distrust Scale...
April 8, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28371289/prolonged-cold-ischemia-time-results-in-local-and-remote-organ-dysfunction-in-a-murine-model-of-vascularized-composite-transplantation
#13
Néha Datta, Sean G Devaney, Ronald W Busuttil, Kodi Azari, Jerzy W Kupiec-Weglinski
Vascularized composite allotransplantation (VCA) is a viable reconstructive option for complex tissue defects. Although grafts with large muscular component may be uniquely susceptible to ischemia/reperfusion (I/R) syndrome, the safe cold ischemia time in VCA has not been established. We investigated the effects of cold ischemia on innate immune response and recipient survival in a murine orthotopic hindlimb transplantation model. Surprisingly, mice receiving grafts exposed to 6h or longer of cold storage demonstrated reduced survival and massive elevations in serum creatinine, BUN and creatine kinase, as compared to 1h of cold storage recipients...
March 30, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28361115/detection-of-donor-derived-microparticles-in-the-peripheral-blood-of-a-hand-transplant-recipient-during-rejection
#14
Joseph Y Kim, Theodoros Kelesidis, Otto O Yang
BACKGROUND: Microparticles (MPs) are released from the plasma membrane of activated or dying cells and bear surface molecules from those cells. We examined whether donor-derived MPs in the peripheral blood of the recipient could serve as a marker of tissue damage due to rejection of a transplanted hand. METHODS: Platelet-free plasma from the recipient of the transplanted hand was analyzed for MPs bearing the donor-specific HLA molecule A*02 using flow cytometry...
March 2017: Transplantation Direct
https://www.readbyqxmd.com/read/28371193/chronic-allograft-deterioration-a-clinical-reality-in-vascularized-composite-allotransplantation
#15
EDITORIAL
N Krezdorn, B Pomahac
No abstract text is available yet for this article.
July 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28340673/the-advent-of-vascularized-composite-allotransplantation
#16
REVIEW
Curtis L Cetrulo, Zhi Yang Ng, Jonathan M Winograd, Kyle R Eberlin
Modern microsurgical techniques have made possible a broad spectrum of novel means for the reconstruction of complex bone and soft tissue defects. These techniques, in combination with developments in transplant immunology, have led to successful hand and facial allotransplantation and achievement of the highest rung in the reconstructive ladder - truly replacing like with like. The utilization of contemporary microsurgical technique in the context of vascularized composite allotransplantation (VCA) (1) permits successful technical execution and feasibility of VCA, (2) facilitates the study of immunologic tolerance in VCA preclinical models, and (3) optimizes functional VCA outcomes...
April 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/22745115/anesthetic-management-in-upper-extremity-transplantation-the-pittsburgh-experience
#17
R Scott Lang, Vijay S Gorantla, Stephen Esper, Mario Montoya, Joseph E Losee, Ibtesam A Hilmi, Tetsuro Sakai, W P Andrew Lee, Jay S Raval, Joseph E Kiss, Jaimie T Shores, Gerald Brandacher, Raymond M Planinsic
BACKGROUND: Hand/forearm/arm transplants are vascularized composite allografts, which, unlike solid organs, are composed of multiple tissues including skin, muscle, tendons, vessels, nerves, lymph nodes, bone, and bone marrow. Over the past decade, 26 upper extremity transplantations were performed in the United States. The University of Pittsburgh Medical Center has the largest single center experience with 8 hand/forearm transplantations performed in 5 recipients between January 2008 and September 2010...
September 2012: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28249789/hand-transplantation-evolution-of-a%C3%A2-personal-outlook
#18
REVIEW
W P Andrew Lee
The field of vascularized composite allotransplantation-combining advances in reconstructive surgery, transplantation, and immunology-offers great promise for patients with heretofore unsolvable problems. In the last 30 years, hand transplantation has progressed through the phases of being a research subject, a controversial clinical procedure, a more widely accepted and expanding field, and now a promising endeavor undergoing refined indications. Although many lessons have been learned, few procedures in the author's experience have been as life-transformative in restoring the body image, motor and sensory functions, activities of daily living, and personal autonomy as successful hand transplantation...
February 26, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28222055/ex-situ-perfusion-of-human-limb-allografts-for-24-hours
#19
Nicole L Werner, Fares Alghanem, Stephanie L Rakestraw, Dylan C Sarver, Bruce Nicely, Richard E Pietroski, Paul Lange, Steven M Rudich, Christopher L Mendias, Alvaro Rojas-Pena, John C Magee, Robert H Bartlett, Kagan Ozer
BACKGROUND: Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance after procurement. In bilateral hand transplantations, this demands a 2 team approach and expedited transfer of the allograft, limiting the recovery to a small geographic area. Ex situ perfusion may be an alternative allograft preservation method to extend allograft survival time. This is a short report of 5 human limbs maintained for 24 hours with ex situ perfusion. METHODS: Upper limbs were procured from brain-dead organ donors...
March 2017: Transplantation
https://www.readbyqxmd.com/read/28211139/scabies-in-a-bilateral-hand-allograft-recipient-an-additional-mimicker-of-acute-skin-rejection-in-vascularized-composite-allotransplantation
#20
Jean Kanitakis, Emmanuel Morelon
Vascularized composite tissue allografts include skin, which frequently undergoes, in the early post-graft period, acute rejections. The diagnosis of acute rejection may be difficult as it can be mimicked by several dermatoses. We present a bilateral hand allograft recipient who developed, 16.5 years post-graft, cutaneous lesions raising suspicion about rejection. Physical examination and skin biopsy were diagnostic of scabies. This ectoparasitosis should be added in the list of dermatoses that can mimic allograft rejection in vascular composite allografts...
June 2017: Transplant Infectious Disease: An Official Journal of the Transplantation Society
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