American Association for Hand Surgery

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Growth in the World's First Pediatric Bilateral Hand Transplant: A 4-Year Follow-up
Said C Azoury, MD1, Rotem Kimia, BA1, Christine McAndrew, PA-C1, David J. Bozentka, MD2, David Steinberg, MD1, Ines Lin, MD1, Stephen J Kovach III, MD1, Robert Carrigan, MD1, L. Scott Levin, MD1 and Benjamin Chang, MD1, (1)University of Pennsylvania, Philadelphia, PA, (2)Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA

Introduction: In 2015, the first bilateral pediatric hand transplant in the world was performed in an 8-year old boy. This patient previously contracted staphylococcal sepsis with systemic ischemic injury at 2 years of age, which led to 4-limb amputation. At the time of transplantation, the potential for longterm growth of transplanted hands was unknown in the growing child. We describe the growth of the transplanted upper extremities over the four years after pediatric hand transplant.


Materials & Methods: Upper extremity forearm (PA and Lateral) and hand (3-view) x-rays were performed at 1-, 2-, 3- and 4- year following bilateral hand-forearm transplantation. Measurements of the radius and ulna length were performed by the authors using digital lateral and PA radiographs. Greulich & Pyle Atlas was used to estimate bone age of upper extremity radiographs. Rate of growth was compared to normative values in the literature. 


Results: From July 2015 to July 2019, increase in forearm bone length were: right ulna 3.7 cm, right radius 3.5 cm, left ulna 3.0 cm, and left radius 3.6 cm. The rate of forearm growth is similar in each upper extremity (Figure). At each subsequent annual follow-up visit, the bone age increased by 1 year based on Greulich & Pyle assessment. Radiographic measurements of ulnar and radial growth in the presented child are similar to reported normative values in non-transplanted pediatric patients and reflective of both the bone and chronologic age of the patient. 


Conclusions: Annual increase in chronologic age parallels the annual increase in bone age in the first pediatric hand-forearm transplants. Growth rate is similar on both transplanted extremities. Successful upper extremity vascularized composite allotransplantation offers the advantage of growth rates similar to established non-transplant norms.


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