Hand Transplantation in Its Fourteenth Year: The Innsbruck Experience

Figures & data

Table 1. Patient characteristics at the time of transplantation

Characteristics	Patient I	Patient II	Patient III	Patient IV	Patient V
Age	47	41	23	55	55
Dominant hand	right	right	right	right	right
Cause of amputation	explosion-1994	electric current accident-2000	explosion-2000	timber machine accident-2004	burning injury-2009
CMV status (rec/don)	negative/positive	positive/positive	positive/positive	negative/negative	negative/negative
PRA pre Tx (%)	5	0	0	0	0
HLA mismatches (A/B/DR)	2/2/2	1/2/1	1/1/1	2/2/2	2/2/2
Transplantation	07.03.2000	17.02.2003	29.05.2006	22.07.2009	26.03.2014
Level	distal forearm	proximal forearm	mid forearm	wrist	right: metacarpal left: wrist

Table 2. Rejection episodes

Patient I	Three rejection episodes: Banff I-II on day 55, 4 and 9.5 y after transplantation
Patient II	Seven rejection episodes: 3 within first 6 months, Banff III rejection on day 345, Banff I rejections at days 473 and 972 and DSA-positive rejection 9 y after transplantation
Patient III	Six rejection episodes: Banff III-IV rejection on day 51, 4 moderate Banff I-II rejection episodes between 1 and 3.5 y posttransplant, Banff II rejection 6 y after transplantation
Patient IV	Three rejection episodes: Banff I on day 15, Banff II-III 1.5 y postransplant, DSA-positive rejection 3.5 y after transplantation
Patient V	One rejection episode: Banff I-II on day 112

Table 3. Complications and side effects

Patient I	Recurrent CMV infection, hyperlipidemia, non insulin-dependent diabetes mellitus, repeated radius fracture, bullous pemphigoid
Patient II	Recurrent CMV infection, invasive fungal infection with Alternaria, HPV associated skin warts, headache, hypertension, oral aphtous lesions
Patient III	CMV infection, hypertension, hyperlipidemia, myocarditis, condyloma
Patient IV	Hypertension, increase of serum creatinine
Patient V	Renal insufficiency

Figure 1. Histology and immunohistochemistry.

Figure 2. 3D-reconstructions of CT-angiography and conventional angiography (A–C) patient #1; (D–H) patient #2; (I–K) patient #3; (L and M) patient #4.

Figure 3. Hand Tansplantation Score System (HTSS) The total score for patient #1: 90.5 for the right and 90 for the left hand; for patient #2: 74 for the right and 71.5 for the left forearm; for patient #3: 86 for the right and 85.5 for the left hand; for patient #4: 80 for the right hand. The hand transplantation score system of the international registry includes appearance (15 points), sensibility (20 points), movement (20 points), psychological and social acceptance (15 points), daily activities and work status (15 points), patient satisfaction and general well being (15 points). 0–30 points &Equals; poor, 31–60 points &Equals; fair, 61–80 points &Equals; good, 81–100 points &Equals; excellent.

Figure 4. Compound Motor Action Potentials (CMAP) Amplitudes of compound motor action potentials recorded from left [▴] and right [♦] m. abductor pollicis brevis, and left [x] and right [▪] m. abductor digiti minimi; abscissa, time after transplantation in years; ordinate, amplitude in mV.