A report of 15 hand allotransplantations in 12 patients and their outcomes in China.

Background. Limb allotransplantation is emerging as a promising solution to the loss of a limb with the development of advanced surgical techniques and new, highly effective immunosuppressive agents. Methods. We retrospectively reviewed the records of 15 hand allotransplantations in 12 patients in China which were performed from September 1999 to May 2008. Results. In total, there were 1 bilateral and 5 unilateral hand transplantations, 3 unilateral and 2 bilateral forearm transplantations, and 1 palm and 1 thumb transplantation. The average age of recipients was 34 +/- 11.3 years (range, 19-52 years). At 1-year follow-up, all grafts were viable and with good function. Of the 15 hands transplanted, 8 are currently viable (mean follow-up, 52 +/- 36.3 months; range, 16-112 months), including all 3 bilateral cases. Reasons for graft failure were rejection and failure of compliance with immunosuppressive therapy. Conclusions. Long-term survival of hand transplantation with appropriate immunosuppression is feasible, and satisfactory functional results have been achieved. Careful pretransplant psychologic and social evaluation, consideration of the financial burden of long-term immunosuppressive medications, and close multispecialty collaboration is critical for good outcomes. Limb rejection was related with immunosuppression use. Further study and experience is required before hand allotransplantation can become a generally recommended treatment.