Background
The primary purpose of the IRHCTT is to collect information on voluntary basis. At present it includes upper extremity (UET) and face allotransplantations (FT).
Methods
25 unilateral and 31 bilateral UET, for a total of 56 patients have been reported. In the majority of cases the level of amputation was distal, but there were also 9 arm transplantations.
Twenty-eight cases of partial or total face allotransplantations have been reported. In the majority of cases the deficit included cheek, nose, chin, lips and perioral area.
In both types of transplantation the immunosuppressive therapy included tacrolimus, mycophenolate mofetil, sirolimus and steroids; polyclonal or monoclonal antibodies were used for induction.
Results
Patient survival in UET was 9637%: 1 patient died after simultaneous face and bilateral hand transplantation and another one after bilateral arm transplantation; while in FT it was 8572% (4 patients died including the case of simultaneous face and bilateral hand transplantation) Graft survival in UET was 8182%: in 5 cases it occurred in the first period after transplantation (poor vascularization or infectious complications) and in other 5 during the follow-up (chronic rejection/graft vasculopathy) Graft survival in FT was 9643% (one face graft was removed for unknown cause).
In UET 74% of the recipients experienced at least one episode of acute rejection within the first post-transplant year and 60% in FT Six cases of chronic rejection in UET and one in FT have been reported Complications included, as in solid organ transplantation, opportunistic infections, metabolic complications and malignancies.
Hand-grafted patients developed protective sensibility, 90% of them tactile sensibility and 823% developed also a partial discriminative sensibility Motor recovery enabling patients to perform most daily activities Face-grafted patients improved their aesthetic aspect and they were able to perform some activities such as eating, drinking and speaking which were impossible before the transplantation.
Conclusions
UET and FT are successful procedures, however careful evaluation of patients before and after transplantation are indispensable.