Long-term outcome after hand and forearm transplantation - a retrospective study
© 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT..
Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long-term results at 20 years. During the 6-20 years follow-up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody-related with serum donor-specific alloantibodies (DSA) and skin-infiltrating B-cells. The cell phenotype in rejecting skin biopsies changed and C4d-staining increased with time post-transplantation. In the long-term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well-being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection-free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
|---|---|
| Enthalten in: |
Transplant international : official journal of the European Society for Organ Transplantation - 33(2020), 12 vom: 20. Dez., Seite 1762-1778 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Hautz, Theresa [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Complications |
|---|
| Anmerkungen: |
Date Completed 24.06.2021 Date Revised 30.03.2024 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1111/tri.13752 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM315417161 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM315417161 | ||
| 003 | DE-627 | ||
| 005 | 20240330232914.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1111/tri.13752 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1356.xml |
| 035 | |a (DE-627)NLM315417161 | ||
| 035 | |a (NLM)32970891 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Hautz, Theresa |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Long-term outcome after hand and forearm transplantation - a retrospective study |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 24.06.2021 | ||
| 500 | |a Date Revised 30.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT. | ||
| 520 | |a Between 2000 and 2014, five patients received bilateral hand (n = 3), bilateral forearm (n = 1), and unilateral hand (n = 1) transplants at the Innsbruck Medical University Hospital. We provide a comprehensive report of the long-term results at 20 years. During the 6-20 years follow-up, 43 rejection episodes were recorded in total. Of these, 27.9% were antibody-related with serum donor-specific alloantibodies (DSA) and skin-infiltrating B-cells. The cell phenotype in rejecting skin biopsies changed and C4d-staining increased with time post-transplantation. In the long-term, a change in hand appearance was observed. The functional outcome was highly depending on the level of amputation. The number and severity of rejections did not correlate with hand function, but negatively impacted on the patients´ well-being and quality of life. Patient satisfaction significantly correlated with upper limb function. One hand allograft eventually developed severe allograft vasculopathy and was amputated at 7 years. The patient later died due to progressive gastric cancer. The other four patients are currently rejection-free with moderate levels of immunosuppression. Hand transplantation remains a therapeutic option for carefully selected patients. A stable immunologic situation with optimized and individually adopted immunosuppression favors good compliance and patient satisfaction and may prevent development of DSA | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a complications | |
| 650 | 4 | |a donor-specific antibodies | |
| 650 | 4 | |a hand and forearm transplantation | |
| 650 | 4 | |a immunosuppression | |
| 650 | 4 | |a rejection | |
| 650 | 4 | |a vascularized composite allotransplantation | |
| 700 | 1 | |a Messner, Franka |e verfasserin |4 aut | |
| 700 | 1 | |a Weissenbacher, Annemarie |e verfasserin |4 aut | |
| 700 | 1 | |a Hackl, Hubert |e verfasserin |4 aut | |
| 700 | 1 | |a Kumnig, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Ninkovic, Marina |e verfasserin |4 aut | |
| 700 | 1 | |a Berchtold, Valeria |e verfasserin |4 aut | |
| 700 | 1 | |a Krapf, Johanna |e verfasserin |4 aut | |
| 700 | 1 | |a Zelger, Bettina G |e verfasserin |4 aut | |
| 700 | 1 | |a Zelger, Bernhard |e verfasserin |4 aut | |
| 700 | 1 | |a Wolfram, Dolores |e verfasserin |4 aut | |
| 700 | 1 | |a Pierer, Gerhard |e verfasserin |4 aut | |
| 700 | 1 | |a Löscher, Wolfgang N |e verfasserin |4 aut | |
| 700 | 1 | |a Zimmermann, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Gabl, Markus |e verfasserin |4 aut | |
| 700 | 1 | |a Arora, Rohit |e verfasserin |4 aut | |
| 700 | 1 | |a Brandacher, Gerald |e verfasserin |4 aut | |
| 700 | 1 | |a Margreiter, Raimund |e verfasserin |4 aut | |
| 700 | 1 | |a Öfner, Dietmar |e verfasserin |4 aut | |
| 700 | 1 | |a Schneeberger, Stefan |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Transplant international : official journal of the European Society for Organ Transplantation |d 1990 |g 33(2020), 12 vom: 20. Dez., Seite 1762-1778 |w (DE-627)NLM012972258 |x 1432-2277 |7 nnns |
| 773 | 1 | 8 | |g volume:33 |g year:2020 |g number:12 |g day:20 |g month:12 |g pages:1762-1778 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1111/tri.13752 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 33 |j 2020 |e 12 |b 20 |c 12 |h 1762-1778 | ||