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Risks Surgical and Medical Acute and Chronic Rejection Removing the Hand Anti-Rejection Medicine Pain and Discomfort Emotional and Social
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Home > Risks > Removing the Hand

Removing the Hand

 

Dr. Dumanian, Chief of Plastic Surgery, talks about why some people with limb loss do not want to take the risk of re-amputation.

Angie Duckworth, Transplant Social Worker, talks about the risk of re-amputation.

 
 

Can the Hand/Arm Transplant Be Removed?

In some cases, the hand/arm transplant may need to be removed (“explantation”) if the transplant recipient experiences serious side effects or health complications.1-3

Reasons Recipients Had Their Hand/Arm Transplant Removed:

There are several reasons why recipients have had their hand/arm transplant removed.3-10

  • Unreported/ongoing rejection episodes
  • Infection
  • Blood clot
  • Intimal hyperplasia: this is the thickening of part of the blood vessel in response to injury
  • Sepsis and necrosis
  • Patients not taking their anti-rejection medicines as prescribed
  • Poor function of the hand/arm transplant
  • Patient’s decision

Risks and Benefits of Hand/Arm Transplant Removal (“Explantation”):

It is important to consider the risks and benefits of removing the hand/arm transplant.

  • Risks of removal include:
    • Complications during surgery
    • Additional recovery time after hand removal
    • Loss of residual limb length. If a hand/arm transplant needs to be removed, then the recipient will end up with a slightly shorter amputation stump than before the transplant. This happens because of technical reasons that relate to wound closure.
    • Decrease in functionality as compared to pre-transplant surgery functionality
    • Difficulty fitting a new prosthetic, or the need to have a new prosthetic because the residual limb will be a different shape or size than it was pre-transplant
    • Unlikely that recipient will be able to receive another hand/arm transplant
  • Benefits of removal include:
    • Ending anti-rejection medicine regimen and preventing potential side effects from the medicines1
 

Mr. Pollock, a bilateral, upper limb transplant recipient (11 ½ years after transplantation), talks about the importance of meeting with one’s doctors and listening to what they say.

 
 

References

Sources

DiMartini A, Dew MA. In Experimental Hand Transplantation, Whose Views about Outcomes Matter Most? AMA Journal of Ethics 2019;21(11):936-942.

  1. Levin LS, Cavadas PC. Reconstructive surgery – The Evolution of VC. Chicago, IL: Symposium session at the World Society for Reconstructive Microsurgery, July 2013.

  2. Tintle, SM., Potter BK, Elliott RM, et al. Hand Transplantation. Journal of Bone and Joint Surgery. 2014;2(1):1-9.

  3. Hettiaratchy S, Melendy E, Randolph MA, et al. Tolerance to Composite Tissue Allografts across a major Histocompatibility Barrier in Miniature Swine. Transplantation 2004;77(4):514-521.

  4. Park S, Eun S, Kwon ST. Hand Transplantation: current status and immunologic obstacles. Experimental and Clinical Transplantation 2019;1:97-104.

  5. Kijani S, Vazquez AM, Levin M, et al. Intimal Hyperplasia Induced by Vascular Intervention Causes Lipoprotein Retention and Accelerated Atherosclerosis. Physiol Rep. 2017;5(14).

  6. Kumnig M., Jowsey-Gregoire SG., DiMartini A. F. Psychological Aspects of Hand Transplantation. Current Opinion in Organ Transplantation 2014;19(2):188-195.

  7. Kanitakis J, Jullien D, Petruzzo P, et al. Clinicopathologic Features of Graft Rejection of the First Human Hand Allograft. Transplantation 2003;76(4):688-693.

  8. Landin L, Cavadas PC, Ibanez J, et al. Malignant Skin Tumor in a Composite Tissue (bilateral hand) Allograft Recipient. Plastic and Reconstructive Surgery 2010;125(1):1-28.

  9. Petruzzo P, Lonzetta M, Dubernard JM et al. The International Registry on Hand and Composite Tissue Transplantation. Clinical and Translational Research 2010;90(12):1590-1594.