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Hand Transplantation
Hand Transplantation
P re f a c e H a n d Tra n s p l a n t a t i o n
Gerald Brandacher, MD W.P. Andrew Lee, MD Guest Editors
successful, the need for long-term and high-dose multidrug immunosuppression to enable graft survival still remains a pace-limiting obstacle toward broader application. We therefore devote an entire section to immunosuppressive protocols and immunological challenges related to hand transplantation and to the recognition of acute and chronic rejection mechanisms. In addition, unlike for solid organs, clinical success in hand transplantation is dictated not only by graft acceptance and survival, but also by nerve regeneration, which determines ultimate functional outcomes. This important topic is dealt with in an article discussing novel strategies and modalities to enhance nerve regeneration. In this regard, several exciting novel therapeutic strategies such as the implementation of cellular and biologic therapies that integrate the concepts of immune regulation with those of nerve regeneration are on the horizon and have shown promising results in experimental models. Such protocols might further optimize functional outcomes and minimize/avoid the need for chronic immunosuppression.
Hand Clin 27 (2011) xiii–xiv doi:10.1016/j.hcl.2011.08.009 0749-0712/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved.
hand.theclinics.com
Reconstructive transplantation has become a clinical reality over the past decade with more than 70 upper limb transplants performed with highly encouraging graft survival and good to excellent functional outcomes. This special issue of Hand Clinics is devoted to Hand Transplantation. The individual authors are leaders in the field with extensive knowledge and expertise in their particular assignments. The goal for this issue is to cover the various multidisciplinary aspects related to hand transplantation with a focus on clinical and immunological outcomes. This is achieved with a series of articles from some of the leading centers performing hand transplantation in Europe and the United States, providing detailed updates on their experience with hand and forearm transplantation. This cumulative world record substantiates the fact that hand transplantation today is a valuable treatment option for the many patients in need suffering from complex tissue injuries or defects where conventional reconstruction is not feasible. However, despite the fact that surgical procedures and functional outcomes are largely
xiv
Preface With more and more centers embarking on reconstructive transplantation, logistical aspects, and standardization of the transplant procedure, patient care and postoperative follow-up are of critical importance. Consequently, a sequence of articles are incorporated in this issue to review surgical techniques, establishment of a hand transplant program, criteria for recipient selection, donorrelated issues, as well as general ethical, financial, and policy considerations of hand transplantation. Today we are on the verge of a new era in upper limb transplantation. The constantly improving safety, efficacy, and applicability of these promising reconstructive modalities hold great promise for patients with devastating injuries or deformities that are not amenable to conventional methods of repair.
Gerald Brandacher, MD Department of Plastic and Reconstructive Surgery Johns Hopkins University School of Medicine Ross Research Building 749D 720 Rutland Avenue Baltimore, MD 21205, USA W.P. Andrew Lee, MD Department of Plastic and Reconstructive Surgery Johns Hopkins University School of Medicine 601 North Caroline Street Baltimore, MD 21287, USA E-mail addresses: [email protected] (G. Brandacher) [email protected] (W.P.A. Lee)
P re f a c e H a n d Tra n s p l a n t a t i o n
Gerald Brandacher, MD W.P. Andrew Lee, MD Guest Editors
successful, the need for long-term and high-dose multidrug immunosuppression to enable graft survival still remains a pace-limiting obstacle toward broader application. We therefore devote an entire section to immunosuppressive protocols and immunological challenges related to hand transplantation and to the recognition of acute and chronic rejection mechanisms. In addition, unlike for solid organs, clinical success in hand transplantation is dictated not only by graft acceptance and survival, but also by nerve regeneration, which determines ultimate functional outcomes. This important topic is dealt with in an article discussing novel strategies and modalities to enhance nerve regeneration. In this regard, several exciting novel therapeutic strategies such as the implementation of cellular and biologic therapies that integrate the concepts of immune regulation with those of nerve regeneration are on the horizon and have shown promising results in experimental models. Such protocols might further optimize functional outcomes and minimize/avoid the need for chronic immunosuppression.
Hand Clin 27 (2011) xiii–xiv doi:10.1016/j.hcl.2011.08.009 0749-0712/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved.
hand.theclinics.com
Reconstructive transplantation has become a clinical reality over the past decade with more than 70 upper limb transplants performed with highly encouraging graft survival and good to excellent functional outcomes. This special issue of Hand Clinics is devoted to Hand Transplantation. The individual authors are leaders in the field with extensive knowledge and expertise in their particular assignments. The goal for this issue is to cover the various multidisciplinary aspects related to hand transplantation with a focus on clinical and immunological outcomes. This is achieved with a series of articles from some of the leading centers performing hand transplantation in Europe and the United States, providing detailed updates on their experience with hand and forearm transplantation. This cumulative world record substantiates the fact that hand transplantation today is a valuable treatment option for the many patients in need suffering from complex tissue injuries or defects where conventional reconstruction is not feasible. However, despite the fact that surgical procedures and functional outcomes are largely
xiv
Preface With more and more centers embarking on reconstructive transplantation, logistical aspects, and standardization of the transplant procedure, patient care and postoperative follow-up are of critical importance. Consequently, a sequence of articles are incorporated in this issue to review surgical techniques, establishment of a hand transplant program, criteria for recipient selection, donorrelated issues, as well as general ethical, financial, and policy considerations of hand transplantation. Today we are on the verge of a new era in upper limb transplantation. The constantly improving safety, efficacy, and applicability of these promising reconstructive modalities hold great promise for patients with devastating injuries or deformities that are not amenable to conventional methods of repair.
Gerald Brandacher, MD Department of Plastic and Reconstructive Surgery Johns Hopkins University School of Medicine Ross Research Building 749D 720 Rutland Avenue Baltimore, MD 21205, USA W.P. Andrew Lee, MD Department of Plastic and Reconstructive Surgery Johns Hopkins University School of Medicine 601 North Caroline Street Baltimore, MD 21287, USA E-mail addresses: [email protected] (G. Brandacher) [email protected] (W.P.A. Lee)