Clinical and Immunological Update 15 Years After the First VCA – Subsequent Kidney Transplantation After a Bilateral Hand Transplant
1Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
2Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Innsbruck, Austria
3Department of Traumatology, Innsbruck Medical University, Innsbruck, Austria
4Department of Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria
5Institute of Pathology, Innsbruck Medical University, Innsbruck, Austria
6Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Meeting: 2015 American Transplant Congress
Abstract number: 343
Keywords: Outcome, Renal injury
Session Information
Session Name: Concurrent Session: Composite Tissue Allografts: Basic and Translational
Session Type: Concurrent Session
Date: Tuesday, May 5, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:27pm-2:39pm
Location: Room 119-A
Background: We herein describe the long term outcome with emphasis on function, immunosuppression (IS), complication and side effects, histomorphology and graft vascular changes 15 years after the first VCA in Innsbruck
Patients: Five patients received a bilateral hand (n=3), a bilateral forearm (n=1) and a unilateral hand transplant (n=1) between 03/2000 and 03/2014. The fifth patient received a subsequent kidney transplantation (KTx) due to a pre-existing kidney injury six months after the bilateral hand transplantation. Induction therapy with antithymocyte globulin or alemtuzumab was followed by tacrolimus, prednisolone ± mycophenolate mofetil (MMF) or tacrolimus and MMF maintenance IS. In patient 5, the induction therapy used for the KTx was basiliximab, followed by a belatacept-based, steroid free, maintenance immunosuppressive protocol.
Results: Hand function correlated with time after transplantation and amputation level and remained stable after year 5 in all cases. Intrinsic hand muscle function recovery, discriminative sensation and temperature sensation were observed after hand transplantation. Three, seven, six, three and one rejection episodes were successfully treated with steroids, anti-CD25, anti-CD52 and anti-CD20 antibodies, intensified maintenance IS and/or plasmapheresis. Skin histology at current shows no or mild perivascular lymphocytic infiltrates without signs of progression. Kidney biopsy did not reveal any form of renal rejection. Hand vessels are patent without signs for luminal narrowing or intimal proliferation.
Conclusion: The overall functional outcome and patient satisfaction are highly encouraging. The kidney function after VCA is excellent and all patients are now free of rejection with moderate levels of IS.
To cite this abstract in AMA style:
Weissenbacher A, Pierer G, Gabl M, Ninkovic M, Hautz T, Grahammer J, Zelger B, Zelger B, Brandacher G, Schneeberger S. Clinical and Immunological Update 15 Years After the First VCA – Subsequent Kidney Transplantation After a Bilateral Hand Transplant [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-and-immunological-update-15-years-after-the-first-vca-subsequent-kidney-transplantation-after-a-bilateral-hand-transplant/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress