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The Clinical Course of Hand Transplantation: Experience of Unanticipated Events
Edward Davidson, MA, (Cantab), MBBS; Alexander Spiess, MD; Mario Solari, MD; Kia Washington, MD; Joseph Losee, MD; Vijay Gorantla, MD
Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA

Introduction: As composite tissue allotransplantation (CTA) of the hand and upper extremity evolves as a new treatment modality, each patient presents a clinical course with new challenges. With increasing postoperative time courses elapsed and increasing numbers of procedures performed, a number of unanticipated clinical events have been encountered at our institution and others. These events can represent clinical diagnostic and treatment dilemmas. The clinical experience of these unanticipated events of the first five hand transplantation recipients at our institution is presented herein

Materials and Methods: All transplants were performed with Institutional Review Board approval, and in accordance with Independent Ethics Committee regulations. A retrospective chart review was performed to identify unanticipated clinical events. The diagnostic and management considerations for each event were reviewed.

Results: For the first five hand transplants at our institution, clinical events encountered have included steroid resistant rejection with subsequent immunoglobulin induced epidermolysis, osseous malunion, thermal injury, scabies infestation, mechanically mediated localised atypical rejection, and undulating edema of unknown aetiology.

Conclusions: Hand transplantation currently remains in a formative stage of growth as a reconstructive treatment modality. The course of each transplant recipient therefore continues to pose clinical conundrums of previously unseen signs and symptoms. These sometimes adverse and moreover unanticipated events are presented so that this may improve knowledge and advance understanding of hand transplantation.

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