Abstract

Up to 1st of April 2009 a total of 46 hand transplants have been performed
worldwide, 2 forearm transplants and 4 arm transplants. Of the hand transplants 22 were single and 11 double transplants. We have experience with three patients, two double hand transplants and one double forearm transplant. The first patient was transplanted in March 2000, the second patient (bilateral forearm) in February 2003 and the 3rd patient in May 2006. Total cold ischemia was between 150 and 211 minutes. HLA-match was 0 in patient 1, 2 in patient 2 and 3 in patient 3. Induction therapy consisted of ATG for 4 days in the first 2 patients and Campath-1H in the third patient. Maintenance immunosuppression comprised Tacrolimus, MMF and Prednisolone. In our longest survivor Tacrolimus was converted to Sirolimus after 4 years. Three rejection episodes were observed in the 1st patient, 6 in the second patient and 4 in the 3rd patient. Rejections were treated with pulsed steroids and steroid resistant rejections with ATG and in one patient an ATG resistant rejection was reversed with Campath-1H. At 9 years our first patient is on low dose Sirolimus plus MMF and the two other patients on a Tacrolimus based triple drug regimen. Functional results are good - excellent up to 9 years following transplantation. Currently, there is no sign of chronic rejection in any of the patients. Per definitionem multiorgan transplantation means transplanting at least 3 or more organs en-bloc and was pioneered by Th. Starzl who named it multivisceral transplantation. Up to 31st of March 2005 a total of 232 multivisceral transplants have been reported to the registry including, however, cases of intestine and stomach transplantation. We have performed our first case in 1989 in a 49-year old male, who became the first long-term survivor ever and 11 further cases thereafter. One year graft survival is close to 80% in patients transplanted in more recent years.

Keywords: Limb Transplantation, Immunosuppression