Hand Transplantation in the United States: A review of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Database.
Hand transplantation is the most common application of vascularized composite allotransplantation (VCA). Since July 3, 2014 VCAs were added to the definition of organs covered by federal regulation (the Organ Procurement and Transplantation Network (OPTN) Final Rule) and legislation (the National Organ Transplant Act). As such, VCA is subject to requirements including data submission. We performed an analysis of recipients reported to the OPTN to have received hand transplantation between 1999-2018. Forty-three patients were identified as having been listed for upper extremity transplantation in the United States. Of these, twenty-two received transplantation prior to July 3, 2014 and ten from then to December 31, 2018. Of those transplanted after 2014, post-transplant functional scores included a decrease in Disabilities of the Arm, Shoulder and Hand questionnaire in 3/10 patients, Carroll test scores ranging from 9-60/99, and monofilament testing with protective sensation achieved in 4/6 patients. Complications included rejection in nine recipients with Banff scores from II-IV. One patient experienced graft failure five days after transplant. Of the remaining patients, two were reported as receiving monotherapy and seven receiving dual or triple immunosuppression therapy. The inclusion of VCA in the OPTN Final Rule standardized parameters for safe implementation and data collection.
Hein, Rachel E., David S. Ruch, Christopher S. Klifto, Fraser J. Leversedge, Suhail K. Mithani, Tyler S. Pidgeon, Marc J. Richard, and Linda C. Cendales. “Hand Transplantation in the United States: A review of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Database..” Am J Transplant, November 15, 2019. https://doi.org/10.1111/ajt.15704.