EDEMA AND REJECTION IN HAND TRANSPLANT RECIPIENTS

Christina Kaufman¹, Laurie Newsome¹, Ann Hodges¹, Ashley Buren¹, Brenda Blair¹, Joseph Kutz¹.

¹Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY, USA.

Purpose: In clinical hand transplantation skin rashes and color changes along with skin biopsies are most often used as an indication to treat rejection. While edema often accompany rashes, swelling or edema by itself has not been an indication for treatment of rejection. In this study we correlated hand volumes as measured by water displacement with clinical course including biopsy histology as well as treated rejection episodes.

Methods: Hand volume was a direct measurement of the water displaced by the transplanted tissue, which included a portion of the forearm in all six cases. We have data on six transplant recipients (5 unilateral and 1 bilateral). Follow up ranges from nearly 12 years to 5 months. This data includes both measurements taken by clinicians as well as data taken by the patients at home after discharge.

Results: During periods of clinical quiescence volumes of the transplanted hand achieved steady levels. In the first two patients, who are nearly 12 and 10 years post transplant, there has been no changes or slight changes reflected in both the transplanted and normal hand with weight gain. On the other hand episodes of rejection are associated with increased hand volumes, which remain elevated after surface skin changes have resolved. Data in patients 3-6 suggest that volumes take 2-4 months to stabilize post transplant, and changes were also seen in the native hand. Variation in volume is patient dependent, but a pattern can be established for each patient, and changes more than 2 standard deviations may be associated with active rejection. We have found some data variability with data aquired from pateints at home.

Conclusions: In the absence of active rejection, the transplanted hand establishes a standard volume. During quiescence periods changes in hand volumes had a standard deviation lower than during active rejection. By graphing hand volumes, a characteristic pattern can be established for each patient. This is a measurement that can easily be performed by the patient at home. This may be a reliable and practical method to detect acute skin rejection prior to development of skin rashes, as well as a means to monitor response to clinical treatment of rejection. However, data collected from patients at home must be carefully monitored and large variations should trigger a re-measurement as soon as possible.