Introduction: In the 14 years since the first successful hand transplant, the procedure has become established and performed around the world. This is an analysis of the graft outcomes in 45 patients who received upper extremity transplantation at 15 centers in the US, Europe & centers excluding China.

Objective: To evaluate the incidence and causes of graft failure among hand transplant recipients from centers in the US, Europe & centers excluding China

Methods: Data was collected from the oral presentations made by teams repesenting European and US programs at the 3^rd Biennial meeting of the American Society of Reconstructive Transplantation held at Chicago in November 2012.

Results: A total of 45 recipients were presented at the meeting. This included bilateral hands (22), above elbow (1); face with bilateral hand (2) and lower limb with bilateral hand (1). The number of transplants performed at the centers ranged from one (at 6 centers) to eight (at 1 center). Overall 8 patients lost their grafts(17.8%): 7 in the first year and 1 in the 3rd year. The type of graft in those who sustained graft loss was: upper limb transplant alone in 5/42 (11.9%) and combined face/ lower limb and hand transplant in 3/3 (100%). The causes of graft loss included peri-operative vascular complications in 3, sepsis in 3 and chronic rejection in 2 (1in year 1 and 1 in the 3rd year). The 3 deaths (6.7%) resulted from sepsis and occurred in the 3 combined transplants. The 8 graft losses occurred across 7 centers.The 1 year graft survival for upper limb transplants is 84% overall and 90.5% for isolated upper limb transplants (excluding combination with face/ lower limb).

Conclusions: The one year graft survival following upper extremity transplant currently stands at 84% (7/45; 1 loss occurred late from chronic rejection) and the chief reasons for graft loss in the early transplant period were vascular complications and sepsis (6/7). Combined VCA transplants (including facial tissue) are associated with increased risk of mortality from sepsis. Future work should be directed at mitigating the increased risk associated with multiple combined VCA transplants and standardization of donor recovery or surgical techniques to minimize vascular or other peri-operative complications. The early results in upper extremity transplantation suggest that the 1 year graft survival and pattern of complication is similar to solid organs – 85% graft survival in deceased donor renal transplantation.

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