Hand Transplantation—Risks and Benefits

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1715427 ◽

2020 ◽

Author(s):

Maria João Lúcio ◽

Ricardo Horta

Keyword(s):

Functional Outcomes ◽

English Language ◽

Hand Transplantation ◽

Team Coordination ◽

Composite Tissue Allotransplantation ◽

Composite Tissue ◽

Risks And Benefits ◽

Ethical Debate ◽

Life Saving ◽

Human Adults

AbstractComposite tissue allotransplantation (CTA) is the culmination of progress in transplantation, allowing the reconstruction of the hand in amputees. Worldwide, more than 100 procedures have been performed. The aim of this work was to understand the hand allotransplantation approach, making known current aspects, risks, and benefits. A PubMed research was realized between October 2018 and March 2019, including terms like “Hand transplantation” AND “Composite tissue allotransplantation,” “Hand transplantation” AND “Functional outcomes,” “Hand transplantation” AND “Immunosuppression,” “Hand prosthetics,” “Hand Transplantation” AND “Ethics.” There were included papers between 1995 and 2018, with English language, amputee human adults, systematic reviews, and clinical studies. Seventy-two papers were fully evaluated. There are technical aspects that influence the procedure like team coordination or surgical technique. It requires a long-life treatment, which has risks such as toxicity or infections. However, it allows the recovery of fine movements, and independence, to perform detailed tasks. The indications must be carefully considered, because some patients benefit from the use of prosthesis. CTA has become an option for amputees so it is important to do more research, to determine the benefits of this procedure. It is not considered a life-saving procedure, so there is an ethical debate because of the risks.

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Composite Tissue Allotransplantation: Hand Transplantation and Beyond

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/00124635-201003000-00001 ◽

2010 ◽

Vol 18 (3) ◽

pp. 127-131 ◽

Cited By ~ 31

Author(s):

Jaimie T. Shores ◽

Gerald Brandacher ◽

Stefan Schneeberger ◽

Vijay S. Gorantla ◽

Andrew W.P. Lee

Keyword(s):

Hand Transplantation ◽

Composite Tissue Allotransplantation ◽

Composite Tissue

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ALEMTUZUMAB INDUCTION IN HAND TRANSPLANTATION: PROGRESS TOWARDS MINIMIZING IMMUNOSUPPRESSION IN COMPOSITE TISSUE ALLOTRANSPLANTATION (CTA)

Transplantation Journal ◽

10.1097/01.tp.0000330477.56560.52 ◽

2008 ◽

Vol 86 (Supplement) ◽

pp. 749 ◽

Cited By ~ 1

Author(s):

M Marvin ◽

K Ravindra ◽

J Buell ◽

C Kaufman ◽

R Nagubandi ◽

...

Keyword(s):

Hand Transplantation ◽

Composite Tissue Allotransplantation ◽

Composite Tissue

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Measurement of Utility Values and Quality of Life in Facial Disfigurement as a Prelude to Composite Tissue Allotransplantation of the Face

Journal of Reconstructive Microsurgery ◽

10.1055/s-2006-955149 ◽

2006 ◽

Vol 22 (08) ◽

Author(s):

Sabrina Cugno ◽

Sheila Sprague ◽

Eric Duku ◽

Achilles Thoma

Keyword(s):

Quality Of Life ◽

Composite Tissue Allotransplantation ◽

Facial Disfigurement ◽

Composite Tissue ◽

Utility Values ◽

The Face

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Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.3.peds13381 ◽

2014 ◽

Vol 14 (1) ◽

pp. 1-11 ◽

Cited By ~ 33

Author(s):

Matthew B. Potts ◽

Sunil A. Sheth ◽

Jonathan Louie ◽

Matthew D. Smyth ◽

Penny K. Sneed ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Functional Outcomes ◽

Arteriovenous Malformations ◽

Target Volume ◽

Neurological Deficits ◽

Single Institution ◽

Risks And Benefits ◽

Scale Scores ◽

Time Of Presentation

Object Stereotactic radiosurgery (SRS) is an established treatment modality for brain arteriovenous malformations (AVMs) in children, but the optimal treatment parameters and associated treatment-related complications are not fully understood. The authors present their single-institution experience of using SRS, at a relatively low marginal dose, to treat AVMs in children for nearly 20 years; they report angiographic outcomes, posttreatment hemorrhage rates, adverse treatment-related events, and functional outcomes. Methods The authors conducted a retrospective review of 2 cohorts of children (18 years of age or younger) with AVMs treated from 1991 to 1998 and from 2000 to 2010. Results A total of 80 patients with follow-up data after SRS were identified. Mean age at SRS was 12.7 years, and 56% of patients had hemorrhage at the time of presentation. Median target volume was 3.1 cm3 (range 0.09–62.3 cm3), and median prescription marginal dose used was 17.5 Gy (range 12–20 Gy). Angiograms acquired 3 years after treatment were available for 47% of patients; AVM obliteration was achieved in 52% of patients who received a dose of 18–20 Gy and in 16% who received less than 18 Gy. At 5 years after SRS, the cumulative incidence of hemorrhage was 25% (95% CI 16%–37%). No permanent neurological deficits occurred in patients who did not experience posttreatment hemorrhage. Overall, good functional outcomes (modified Rankin Scale Scores 0–2) were observed for 78% of patients; for 66% of patients, functional status improved or remained the same as before treatment. Conclusions A low marginal dose minimizes SRS-related neurological deficits but leads to low rates of obliteration and high rates of hemorrhage. To maximize AVM obliteration and minimize posttreatment hemorrhage, the authors recommend a prescription marginal dose of 18 Gy or more. In addition, SRS-related symptoms such as headache and seizures should be considered when discussing risks and benefits of SRS for treating AVMs in children.

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