Donor–recipient matching in hand transplantation: a comparison of anthropometric measurements, 3-dimensional virtual models and printed epitheses

Donor–recipient matching in hand transplantation remains challenging. The usefulness of three-dimensional (3-D) virtual models and printed epitheses were compared with measurements on cadaveric extremities to evaluate the most accurate method of donor–recipient matching for allograft procurement. Ten anthropometric measurements were recorded from 12 human cadaveric upper extremities and matched to printed epitheses and 3-D virtual models. Five circumferential and two longitudinal measurements obtained an intra-class correlation of >0.75 with all three methods, with the Kaplan (0.973) and wrist circumferences (0.942) achieving the highest concordance. Measurement on cadaveric specimens was the most reliable method. Using different combinations of donor hand and recipient forearms, a series of 72 virtual transplantations were then created, and their compatibility rated by ten transplant surgeons. The results confirmed that anthropometric measurements, obtained directly from potential human donor limbs and based on wrist circumference as the primary parameter, provide the best and most clinically relevant donor–recipient match.

Hand Transplantation—Risks and Benefits

Composite 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.

Abnormal Nailfold Capillaries in Patients after Hand Transplantation

Background: The development of graft vasculopathy may play a role in the long-term deterioration of hand grafts. The aim of study was to examine the patterns of the nailfold capillaries in hand transplant recipients. Methods: the study was performed on six patients who received hand transplantation. To normalize for the effect of immunosuppression an age- and sex-matched group of 12 patients with active kidney transplant was selected. As an additional control group, 12 healthy volunteers were recruited. Nailfold videocapillaroscopy was performed in all participants. Additionally, serum concentrations of vascular endothelial growth factor (VEGF) were measured. Results: Videocapillaroscopic examination of the hand allografts revealed significant abnormalities: including capillary disorganization and microhaemorrhages. The number of capillaries was reduced, the vessels were enlarged and branched. Surprisingly, similar, albeit slightly less pronounced, changes were seen in the nailfolds of healthy hands of the limb transplant recipients. In kidney transplant recipients the capillaroscopic pattern was general normal and comparable to healthy individuals. Moreover, serum concentrations of VEGF in all participants correlated with average capillary diameter in capillaroscopy. Conclusions: in hand transplant recipients advanced microvascular abnormalities are found in nailfold capillaroscopic pattern in both transplanted and own extremities connected with elevated levels of VEGF.