One Year Experience of the Hand Allotransplantation First Performed after Korea Organ Transplantation Act (KOTA) Amendment

Abstract

The revision of the Korea Organ Transplantation Act (KOTA) in 2018 included hand/arm among the organs that can be transplanted. The first hand transplantation since the revision of KOTA took place in January 2021. A 62-year-old male patient experienced hand amputation on July 13, 2018, by a catapult injury. The patient first visited our institute 3 months after the injury. After serial interviews and an overall evaluation, the patient was registered on the hand transplantation waiting list in January 2020. On January 9, 2021, the patient underwent hand transplantation at the right distal forearm level. The total operation time was 17 hours 15 minutes, and the cold ischemic time was 4 hours 9 minutes. Postoperative immunosuppression was administered based on the protocol used for kidney transplantation. Two acute rejection episodes occurred, on postoperative days 33 and 41. Both rejection episodes were reversible with rescue therapy of a higher tacrolimus trough level, steroid pulse therapy, and topical immunosuppressants. Controlled passive range of motion exercise was started on postoperative day 10. Dynamic splint was applied on postoperative day 18. At 1 year, graft maintenance and functional improvement were satisfactory, and the patient showed a Disabilities of Arm, Shoulder and Hand score of 25.8. We successfully performed the first hand transplantation surgery under the KOTA amendment. It came from the organic and effective cooperation of plastic, orthopaedic, and transplantation departments and we believe it will guarantee the future ongoing success.

Keywords

composite tissue allotransplantation - vascularized composite allografting - hand transplantation

• References

• 1 Dubernard JM, Owen E, Herzberg G. et al. Human hand allograft: report on first 6 months. Lancet 1999; 353 (9161): 1315-1320
• 2 Petruzzo P, Lanzetta M, Dubernard JM. et al. The international registry on hand and composite tissue transplantation. Transplantation 2008; 86 (04) 487-492
• 3 Committee for New Health Technology Assessment. : Hand transplantation new health technology assessment report (H31-2010-36); 2010
• 4 Eun SC. Facial transplantation surgery. Arch Plast Surg 2014; 41 (02) 174-180
• 5 Woo SH, Kim YW, Cheon HJ. et al. Process of obtaining social consensus and 3-year functional outcomes of the first hand allotransplantation in Korea. J Korean Med Sci 2021; 36 (02) e6
• 6 Internal Organs Transplant Act. Act No. 17214. 2018
• 7 Dubernard JM, Owen E, Lefrançois N. et al. First human hand transplantation. Case report. Transpl Int 2000; 13 (suppl (Suppl. 01) S521-S524
• 8 Ravindra KV, Buell JF, Kaufman CL. et al. Hand transplantation in the United States: experience with 3 patients. Surgery 2008; 144 (04) 638-643 , discussion 643–644
• 9 Jones NF. Concerns about human hand transplantation in the 21st century. J Hand Surg Am 2002; 27 (05) 771-787
• 10 Schuind F, Abramowicz D, Schneeberger S. Hand transplantation: the state-of-the-art. J Hand Surg Eur Vol 2007; 32 (01) 2-17
• 11 Ibrahim A, Aboelnaga A, Mehanna A. et al. Hand replantation case report using a single vein anastomosis in a severe crush injury. Clin Surg 2020; 5: 2727
• 12 El-Sayed Ahmed MM. Hand replantation: a rare case report. SAGE Open Med Case Rep 2013; 1: X13511601
• 13 Kaufman CL, Ouseph R, Blair B. et al; Graft Vasculopathy in Clinical Hand Transplantation. Graft vasculopathy in clinical hand transplantation. Am J Transplant 2012; 12 (04) 1004-1016