Chapter category: Transplant
Rationale for Hand Transplantation
Hand Transplantation
Edited by: Vijay S. Gorantla and Warren C. BreidenbachISBN: TBA
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Chapter authors:
Justin M. Sacks and W.P. Andrew Lee
Hand transplantation is a clinical reality that offers immense reconstructive potential. Benefits of human hand allografts based on reviews of replantation literature are fa- vorable for significant functional return. The role of immunosuppression in allograft survival is revealed in its relationship to rodent, large animal and primate models. Chronic immunosuppression is required for prevention of allograft rejection in rodents, while combination therapy reduces side‑effects. Tolerance has been observed in large animal models with proper MHC matching and short course immunosuppression while primate models revealed unpredictable allograft survival. Chronic immunosuppression leads to drug specific toxicities, post‑transplant malignancy and opportunistic infections. Risk‑benefit analysis for using chronic immunosuppression must be carefully considered in future hand transplantation procedures. Further experimental investigation is required to alter the unfavorable risk‑benefit ratio of chronic immunosuppression involving tolerance‑inducing modalities and the reduction or elimination of chronic immunosuppression. Hand transplantation will then represent the next advance in reconstructive surgery.
Justin M. Sacks
W.P. Andrew Lee
Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
Additional chapters from this book:
Assessment and Management of Rejection in Hand Transplantation
Stefan Schneeberger and Raimund Margreiter
In 18 hand transplant recipients, 25 rejection episodes have been observed within the first year and two hands have been lost due to rejection. Acute rejection therefore represents the major thr...
Psychological Considerations in Hand Transplantation
Martin M. Klapheke
Psychiatric consultation can play an important role in the assessment of candidates for solid organ transplantation.1 It can be even more critical in the assessment and manage- ment of patients w...
T-Cell Depletion Strategies for Tolerance Induction: Potential Application in Composite Tissue Transplantation
Erik Schadde and Stuart J. Knechtle
The clinical experience with immunosuppression in composite tissue allografts (CTA) is still small compared with the experience in solid organ transplantation. By 1998 and 2005, 24 hands have be...
Perspectives on Chronic Rejection after Hand Transplantation
Vijay S. Gorantla, Carolyn D. Burns and Warren C. Breidenbach
World experience has shown us that acute rejection after hand transplantation is immunologically similar to that in solid organ transplants. The risks of chronic rejection are real after hand tr...
Ethical Criteria for Evaluating Hand Transplantation
Mark A. Rothstein and Heather Hinds
Abuses in biomedical research involving human subjects provided a major impetus to establish the field of interdisciplinary, critical inquiry now known as bioethics,1 and regulation of research re...
Decision Analysis in Hand Transplantation
Stephen E. Edgell
Hand transplantation, as with all medical procedures, provides to the patient the possibility of an improved life along with risks. A decision to have or to not have a hand transplant is one t...
The Evolution and History of Hand Transplantation and Current Status of Composite Tissue Allotransplantation
Chad R. Gordon and Charles W. Hewitt
Composite tissue allotransplantation (CTA) involves “transplanting a graft, composed of a variety of heterogeneous antigenic tissues, across a genetic mismatch,” as in the case of a hand (i....
Rationale for Hand Transplantation
Justin M. Sacks and W.P. Andrew Lee
Hand transplantation is a clinical reality that offers immense reconstructive potential. Benefits of human hand allografts based on reviews of replantation literature are fa- vorable for significan...
