Second report (1998-2006) of the International Registry of Hand and Composite Tissue Transplantation
Second report (1998-2006) of the International Registry of Hand and Composite Tissue Transplantation
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DOI：
10.1016/j.trim.2007.03.002
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发表时间：
2007-07-01
影响因子：
1.5
通讯作者：
Zhang, Xinying
中科院分区：
文献类型：
--
作者：
Lanzetta, Marco;Petruzzo, Palmina;Zhang, Xinying
自2002年5月以来，所有进行手部移植的团体都向国际手部和复合组织移植登记处提供了详细信息。从1998年9月到2006年2月，18例男性患者共接受了24例手/前臂/手指移植（11例单侧和4例双侧手移植，2例双侧前臂移植，1例拇指移植）。截肢平面多在前臂远端或腕部。患者平均年龄为32岁。失去手的时间从2个月到22年不等。免疫抑制治疗包括他克莫司、霉酚酸酯、雷帕霉素和类固醇;多克隆或单克隆抗体用于诱导。部分患者给予局部免疫抑制。随访34 ~ 85个月，生存率100%。移植物存活率在第1年和第2年均为100%。后来发生了2例移植物失败，是由1例不依从患者的严重炎症和进行性排斥反应引起的。此外，由于中国受者没有接受免疫抑制治疗，6只手因排斥过程而丧失。这些失败在2006年1月被告知。12例患者在第一年内发生急性排斥反应。在所有依从性患者中，排斥反应是完全可逆的。副作用包括机会性感染和代谢并发症。由于很难以标准化的方式分析移植功能结果，登记处采用了功能评分系统。所有患者均获得了保护性感觉，其中17例还获得了辨别性感觉。外在和内在肌肉恢复使患者能够进行大部分日常活动，90%的接受者重返工作岗位，提高的手工技能不仅使他们能够恢复以前的工作，而且在某些情况下，还能找到更合适的工作。15名接受者报告了他们的生活质量的改善，我们评价为一个非常重要的点，因为患者的满意度和幸福感是手移植的强制性目标。(C)2007 Elsevier B. V.保留所有权利。
Since May 2002 all groups performing hand transplantations have supplied detailed information to the International Registry on Hand and Composite Tissue Transplantation. This report provides a review of all hand transplants performed to date.From September 1998 to February 2006 eighteen male patients underwent 24 hand/forearm/digit transplantations (eleven unilateral and four bilateral hand transplantations, two bilateral forearm transplantations, one thumb transplantation). The level of amputation was mostly at the distal forearm or wrist. Patient average age was 32. Time since hand loss ranged from 2 months to 22 years. Immunosuppressive therapy included tacrolimus, mycophenolate mofetil, rapamycin and steroids; polyclonal or monoclonal antibodies were used for induction. Topical immunosuppression was administered in some patients. Follow-up period ranged from 34 to 85 months.Patient survival was 100%. Graft survival was 100% at I and 2 years. Two cases of graft failure at a later date occurred and were caused by severe inflammation and progressive rejection in a non-compliant patient. In addition, 6 hands were lost due to a rejection process as the Chinese recipients did not take their immunosuppressive treatment. These failures were communicated in January 2006.Acute rejection episodes occurred in 12 patients within the first year. Rejection was completely reversible in all compliant patients. Side-effects included opportunistic infections and metabolic complications. No life-threatening complications or malignancies were reported.As it would have been very difficult to analyse transplantation functional results in a standardized way, the Registry has performed a functional score system. All patients had achieved protective sensation and in 17 of them also discriminative sensation. Extrinsic and intrinsic muscle recovery enabled patients to perform most daily activities and 90% of the recipients returned to work, and improved manual skills allowed them not only to resume their previous jobs but also, in some cases, to find more suitable employment. Fifteen recipients reported an improvement of their quality of life and we evaluated as a very important point as patient satisfaction and well-being are mandatory goals of hand transplantation. (C) 2007 Elsevier B.V. All rights reserved.