Outcomes after bilateral hand allotransplantation: a risk/benefit ratio analysis.
Outcomes after bilateral hand allotransplantation: a risk/benefit ratio analysis.
复制标题
双侧手同种异体移植后的结果：风险/效益比分析。
作者：
P. Petruzzo;A. Gazarian;Jean Kanitakis;H. Parmentier;V. Guigal;M. Guillot;C. Vial;J. Dubernard;E. Morelon;L. Badet
背景
1998年异体手移植开创了异体复合组织移植的临床时代，但由于该手术的终身免疫抑制、风险效益比不明确、远期功能效果不确定等原因，引起了许多争议和怀疑。本研究的目的是评估双侧同种异体手移植的结果和风险/效益平衡。
方法
该研究包括在一个中心进行的5例双侧同种异体手移植，随访时间为3 - 13年。受试者（4名男性，1名女性）均为年轻人。除2例患者在前臂中段截肢外，所有病例的截肢水平均为远端。所有受者最初接受相同的免疫抑制治疗，包括他克莫司、吗替麦考酚酯、泼尼松和用于诱导的抗胸腺细胞球蛋白。
结果
患者和移植物存活率为100%。所有受试者均表现出充分的感觉运动恢复（保护性和触觉敏感性以及内在肌肉的部分恢复），他们能够进行大部分日常生活活动，并有正常的社交生活。大多数并发症发生在移植后的第一年，并得到成功管理。所有受者都经历了至少1次急性排斥反应，这很容易通过增加口服类固醇剂量或静脉注射类固醇逆转，除了患者3，他出现了6次急性排斥反应，最近2次用Campath-1H治疗。
结论
虽然双侧手移植可能是一个令人满意的治疗选择截肢者，仔细选择的候选人和移植后接受者的严格评估是必要的。
BACKGROUND
The clinic era of composite tissue allotransplantation was inaugurated by hand allotransplantation in 1998, giving rise to many controversies and scepticism because of the lifelong immunosuppression, the unclear risk-benefit ratio, and the uncertain long-term functional results of the procedure. The aim of this study was to evaluate the outcomes and the risk/benefit balance in bilateral hand allotransplantation.
METHODS
The study included 5 cases of bilateral hand allotransplantation performed in a single center, with a follow-up ranging from 3 to 13 years. The recipients (4 men, 1 woman) were young. The level of amputation was distal in all cases except for 2 patients amputated at the midforearm level. All the recipients initially received the same immunosuppressive treatment that included tacrolimus, mycophenolate mofetil, prednisone, and, for induction, antithymocyte globulins.
RESULTS
Patient and graft survival was 100%. All recipients showed adequate sensorimotor recovery (protective and tactile sensitivity and partial recovery of intrinsic muscles), they were able to perform the majority of activities of daily living, and had a normal social life. Most complications occurred in the first posttransplant year and were successfully managed. All recipients experienced at least 1 episode of acute rejection, which was easily reversed by increasing oral steroid dose or by intravenous steroids, except for patient 3, who presented 6 episodes of acute rejection, the latest 2 treated with Campath-1H.
CONCLUSIONS
Although bilateral hand transplantation may be a satisfactory treatment option for amputees, a careful selection of candidates and a rigorous evaluation of recipients after transplantation are imperative.