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First Pediatric Hand Transplant- Outcome at One Year
Lin Lin Gao, MD1; David L. Colen, MD1; L. Scott Levin, MD, FACS1; Benjamin Chang, MD; FACS2
1University of Pennyslvania, Philadelphia, PA; 2Perelman School of Medicine, Philadelphia, PA

Introduction: In July 2015, the first bilateral pediatric hand transplant was performed on an eight-year-old patient already on immunosuppression for a renal transplant earlier in life. Here we present his clinical outcome one year after transplantation.

Methods: Using a multi-team approach, the hand transplant procedure was successfully performed in ten hours. Our rejection protocol included 2mm skin-biopsies performed weeks for eight weeks, then monthly starting three months after transplantation, then quarterly for second year. We obtained his outcomes from his clinical visits with the surgical team, nephrology, infectious disease, neuropsychology and occupational therapy.

Results: The patient had several episodes of Banff grades I and II rejection episodes treated with topical tacrolimus and betamethasone and grade III rejection treated with solumedrol. Two months after transplant, immunosuppression regimen was changed to sirolimus in addition to tacrolimus prednisone and MMF due to rising creatinine with concerns of calcineurin inhibitor toxicity. Currently, patient is able to perform most activities of daily living independently: dress himself, brush his teeth, wipe after toileting, use utensils during meals and write with marker. Transcranial magnetic stimulation showed cortical representation of hand motor activity consistent with high degree of neuroplasticity. To address concerns regarding attention and impulse control that may impact his recovery, behavior modifications such as frequent breaks during therapy, using positive rewards and improving sleep in spite of demanding schedules were made to improve his motivation. His support system at home remained robust and responsive.

Conclusion: Not only has the first pediatric transplant patient demonstrated full compliance with treatment and rehabilitation, he gained ability to perform activities of daily living and independence from caregivers. The patient was re-integrated to school at 10 months post operatively.

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