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Presenter: Christina, Kaufman, Louisville, KY, USA
Authors: Christina Kaufman, Tsu-Min Tsai, Luis Scheker, Warren Breidenbach, Huey Tien, Tuna Ozyurekoglu, Rodrigo Moreno, Michelle Palazzo, Rodrigo Banegas, Brenda Blair, Rosemary Ouseph, Michael Marvin, Joseph Kutz
Christina Kaufman1,2, Tsu-Min Tsai1,2,3, Luis Scheker1,2,3, Warren Breidenbach2,3, Huey Tien2,3, Tuna Ozyurekoglu2,3, Rodrigo Moreno2,3, Michelle Palazzo2,3, Rodrigo Banegas1,2, Brenda Blair1, Rosemary Ouseph4, Michael Marvin4, Joseph Kutz1,3,2.
1Christine M. Kleinert Institute; 2University of Louisville, Division of Hand Surgery; 3Kleinert Kutz Hand Care Center; 4University of Louisville, Louisville, KY, USA.
In the last twelve years six patients have been transplanted with seven hand allografts by the multidisciplinary team of the Louisville CTA Program. The results have far exceeded the initial expectations. The overall course of these patients will be presented, with challenges we have faced, and how our immunosuppressive regimens and our surgical and treatment approach has evolved over the last decade.
The data was reviewed with respect to function, sensitivity, patient satisfaction, immunosuppression, complications, vasculopathy and development of DSA. Follow up is 12 years to 5 months post transplant. The first five patients received a unilateral transplant. The sixth patient was a burn victim, and required amputation of scarred tissue from both hands prior to his bilateral transplant. With the exception of the graft loss in patient #4, the functional outcome has been good to excellent. In patient #4 the graft was lost due to ischemia secondary to severe intimal hyperplasia at 9 months post transplant. Immunosuppression minimization in patients 3-5 may be associated with vasculopathy. We have resumed triple drug therapy for patient #6. This patient is notable for amputation at the level of the wrist at the time of transplant, with connection of donor nerves at the level of palm in both hands. He also experienced wound coverage issues and vascular insufficiency in the right hand. Poor flow, coupled with a rejection episode at day 83 resulted in ischemic loss of the distal phalanx of the thumb and fifth digit. Function in this patient is very good, and he has been discharged to his hometown. Function in the remaining patients continues to increase, with improved ability to detect textures even at 11 years post tx.
With the exception of the graft loss, functional outcome and patient satisfaction have far exceeded early predictions. Our first two patients, maintained on triple drug therapy have done well, with no or acceptable transplant related complications at more than 10 years post transplant. With novel methods of monitoring vasuclopathy we are committed to identifying the minimum amount of immunosuppression required to maintain the graft. Multi-center trials will be needed to determine the optimum immunosuppressive strategy for CTA.
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