Hand transplantation in the United States: A review of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Database

• Published in: American journal of transplantation Vol. 20; no. 5; pp. 1417 - 1423
• Main Authors: Hein, Rachel E., Ruch, David S., Klifto, Christopher S., Leversedge, Fraser J., Mithani, Suhail K., Pidgeon, Tyler S., Richard, Marc J., Cendales, Linda C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.05.2020
• Subjects: Arm; Data collection; Databases, Factual; Federal regulation; Graft rejection; graft survival; Grafts; Hand; Hand Transplantation; health services and outcomes research; Humans; Immunosuppression; Legislation; Organ Procurement and Transplantation Network (OPTN); Organ Transplantation; registry/registry analysis; Tissue and Organ Procurement; Transplantation; Transplants & implants; United States; Vascularized Composite Allotransplantation; vascularized composite and reconstructive transplantation; United States; United States > US; graft survival; Organ Procurement and Transplantation Network (OPTN); vascularized composite and reconstructive transplantation; registry/registry analysis; health services and outcomes research
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.15704

Hand transplantation is the most common application of vascularized composite allotransplantation (VCA). Since July 3, 2014, VCAs were added to the definition of organs covered by federal regulation (the Organ Procurement and Transplantation Network (OPTN) Final Rule) and legislation (the National Organ Transplant Act). As such, VCA is subject to requirements including data submission. We performed an analysis of recipients reported to the OPTN to have received hand transplantation between 1999 and 2018. Forty‐three patients were identified as having been listed for upper extremity transplantation in the United States. Of these, 22 received transplantation prior to July 3, 2014 and 10 from then to December 31, 2018. Of patients transplanted after 2014, posttransplant functional scores included a decrease in Disabilities of the Arm, Shoulder and Hand questionnaire in 3 of 10 patients, Carroll test scores ranging from 9 to 60 of 99, and monofilament testing with protective sensation achieved in 4 of 6 patients. Complications included rejection in nine recipients with Banff scores from II‐IV. One patient experienced graft failure 5 days after transplantation. Of the remaining patients, two were reported as receiving monotherapy and seven receiving dual or triple immunosuppression therapy. The inclusion of VCA in the OPTN Final Rule standardized parameters for safe implementation and data collection. The authors review the Organ Procurement and Transplantation Network database on upper extremity transplantation after the Final Rule in July 2014.