Shores Jaimie T, Brandacher Gerald, Lee W P Andrew
Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine.
Plast Reconstr Surg. 2015 Feb;135(2):351e-360e. doi: 10.1097/PRS.0000000000000892.
Hand/upper extremity transplantation is the most common form of vascularized composite allotransplantation performed to date. An Update of worldwide outcomes is reported.
The authors summarize the international experience with 107 known transplanted hand/upper extremities in 72 patients. Data from published medical literature, national and international meetings, lay press reports, and personal communications were utilized to provide the most up-to-date summary.
Although 24 losses (including four mortalities) are known, three of the four reported mortalities and eight of 24 limb losses were caused by multiple type vascularized composite allotransplantations (combined upper and lower limb or upper limb and face). Seven more losses were attributable to 15 patients in the early experience in China. In the United States and Western Europe, only three other non-acute graft losses have been reported, resulting in a patient survival rate for unilateral or bilateral hand transplantation in isolation of 98.5 percent and an overall graft survival rate of 83.1 percent.
Published functional outcomes continue to demonstrate improvement in function and quality of life. The international experience supports the idea that, for properly selected individuals, hand and upper extremity transplantation should be considered an important treatment option.
手部/上肢移植是迄今为止进行的血管化复合组织异体移植最常见的形式。本文报告了全球范围内移植结果的最新情况。
作者总结了72例患者107例已知手部/上肢移植的国际经验。利用已发表的医学文献、国内和国际会议、大众媒体报道以及个人交流的数据，提供了最新的总结。
尽管已知有24例移植失败（包括4例死亡），但4例报告的死亡病例中有3例以及24例肢体移植失败中有8例是由多种类型的血管化复合组织异体移植（上肢和下肢联合或上肢和面部联合）导致的。另外7例移植失败归因于中国早期经验中的15例患者。在美国和西欧，仅报告了另外3例非急性移植物丢失，单纯单侧或双侧手部移植的患者生存率为98.5%，总体移植物生存率为83.1%。
已发表的功能结果继续表明功能和生活质量有所改善。国际经验支持这样一种观点，即对于适当选择的个体，手部和上肢移植应被视为一种重要的治疗选择。
