The United Kingdom Hand and Upper Limb Transplantation Service: A report on the first twelve years of a single-center, single-protocol clinical cohort

IF 2.4 3区医学 Q2 SURGERY

Journal of Plastic Reconstructive and Aesthetic Surgery Pub Date : 2025-05-13 DOI:10.1016/j.bjps.2025.05.001

David A. Leonard , Ibrahim Natalwala , Sarah Taplin , Joanna Burdon , Emily L. Clarke , Adrienne Seitz , Will Merchant , Daniel J. Wilks , Brendan Clark , Maggie Bellew , Richard J. Baker , Grainne Bourke , Simon PJ Kay

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引用次数: 0

Abstract

Background

Following the world’s first case (1998), proof of concept was established for hand and upper limb transplantation (HAUL-T). By 2012, there was sufficient evidence for the United Kingdom HAUL-T service to be established on a standard of care basis. A commitment was made to report in detail on this prospective, single-center, single-protocol series. We provide the first comprehensive report on the procedures, surgical, functional, immunological and psychosocial outcomes of the United Kingdom (UK) HAUL-T service.

Methods

Potentially suitable patients undergo sequential psychological and immunological evaluation over one year. Immunosuppression is induced with alemtuzumab, and maintained with tacrolimus, mycophenolate mofetil and prednisolone. Surgical techniques vary with the level of amputation. Rejection monitoring is clinical, with biopsy when indicated. Psychological follow-up is routine, immunosuppression monitoring and hand therapy delivery are shared with the teams local to the recipient.

Annual review in Leeds includes SF-36 and patient satisfaction questionnaires, a suite of functional outcome measures, measurement of grip and pinch strength, Semmes-Weinstein monofilament testing, Sollerman Hand Function, and Box & Blocks Tests.

Results

Ten patients have received 17 transplanted limbs, with follow-up between 6 months and 11 years. Graft survival is 100%. Five patients have produced donor-specific antibodies (DSA). All report overall psychosocial benefit. All demonstrate sensory and motor recovery at least sufficient for functional integration. Six patients have more than 4 years of follow-up, of which 4 demonstrate clinically significant improvements in composite functional scores. Nine have undergone secondary surgery. Post-transplant renal impairment is significantly more severe in patients with a prior history of dialysis.

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英国手部和上肢移植服务：一份关于前12年单中心、单方案临床队列的报告

继1998年世界首例病例之后，手部和上肢移植（HAUL-T）的概念证明得以确立。到2012年，有足够的证据表明，联合王国的HAUL-T服务将建立在护理标准的基础上。我们承诺详细报道这一前瞻性、单中心、单协议系列。我们提供了第一份关于英国（UK） HAUL-T服务的程序，外科，功能，免疫学和心理社会结果的综合报告。方法对符合条件的患者进行为期一年的序贯心理和免疫评价。免疫抑制由阿仑单抗诱导，并由他克莫司、霉酚酸酯和强的松龙维持。手术技术随截肢程度的不同而不同。临床监测排斥反应，必要时进行活检。心理随访是常规的，免疫抑制监测和手部治疗与接受者当地的团队共享。利兹的年度审查包括SF-36和患者满意度问卷，一套功能结果测量，握力和捏力测量，Semmes-Weinstein单丝测试，Sollerman手功能和Box &；块测试。结果10例患者共接受17例肢体移植，随访6个月~ 11年。移植成活率为100%。5名患者产生了供体特异性抗体（DSA）。所有人都报告了整体的心理社会益处。所有患者的感觉和运动恢复至少足以实现功能整合。6例患者随访时间超过4年，其中4例患者综合功能评分有临床显著改善。其中9人接受了二次手术。有透析史的患者移植后肾功能损害更为严重。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Plastic Reconstructive and Aesthetic Surgery 医学-外科

CiteScore

3.10

自引率

11.10%

发文量

578

审稿时长

3.5 months

期刊介绍： JPRAS An International Journal of Surgical Reconstruction is one of the world''s leading international journals, covering all the reconstructive and aesthetic aspects of plastic surgery. The journal presents the latest surgical procedures with audit and outcome studies of new and established techniques in plastic surgery including: cleft lip and palate and other heads and neck surgery, hand surgery, lower limb trauma, burns, skin cancer, breast surgery and aesthetic surgery.