Park Seong Hyuk, Eun Seok-Chan, Kwon Sung Tack
From the Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea.
Exp Clin Transplant. 2019 Feb;17(1):97-104. doi: 10.6002/ect.2018.0163.
Hand transplantation is the most common form of modern composite tissue allotransplantation, with 89 cases reported worldwide since 1998. The procedure is a treatment option for complex injuries that leave patients with structural, functional, and aesthetic deficits that cannot be addressed by other means. Successful application of this technology requires a multidisciplinary approach, incorporating not only skilled hand surgeons, transplant surgeons, and transplant immunologists, but also hand therapists, psychiatrists, medical specialists, anesthesiologists, and so on. Its long-term results depend on proper patient selection, a technically successful operation, postoperative rehabilitation, and an immunotherapy protocol that prevents rejection. Recent advances in transplant immunology are shifting the focus from immunosuppression to immunoregulation. Despite the enormous antigen load associated with composite tissue allografts, hand transplant has become a clinical reality, with immunosuppression comparable to that of solid-organ transplants. Our understanding of hand transplantation is still evolving, and ongoing research is needed to improve functional outcomes and to decrease the morbidity associated with long-term immunosuppression. This review discusses the current protocols for upper extremity donation, transplant receipt, surgical techniques, postoperative rehabilitation and immunosuppression, nerve regeneration, functional outcomes, ethical issues, and financial considerations.
手部移植是现代复合组织同种异体移植最常见的形式，自1998年以来全球已报告89例。该手术是针对复杂损伤的一种治疗选择，这些损伤会给患者留下无法通过其他方式解决的结构、功能和美观缺陷。这项技术的成功应用需要多学科方法，不仅要纳入熟练的手外科医生、移植外科医生和移植免疫学家，还要有手部治疗师、精神科医生、医学专家、麻醉师等等。其长期效果取决于合适的患者选择、技术上成功的手术、术后康复以及防止排斥反应的免疫治疗方案。移植免疫学的最新进展正在将重点从免疫抑制转向免疫调节。尽管复合组织同种异体移植存在巨大的抗原负荷，但手部移植已成为临床现实，其免疫抑制情况与实体器官移植相当。我们对手部移植的理解仍在不断发展，需要持续研究以改善功能结果并降低与长期免疫抑制相关的发病率。本综述讨论了上肢捐献、移植接受、手术技术、术后康复与免疫抑制、神经再生、功能结果、伦理问题以及财务考量的当前方案。
