ROSEMONT, Ill.-Despite the early success of a hand transplant in France, a U.S. specialty group has given a thumbs-down to the procedure.
The American Society for Surgery of the Hand here says the “risk-to-benefit ratio for the successful transplantation of a cadaveric hand has yet to be convincingly established.” Essentially, it called for a moratorium.
The group says the systemic dangers of infection and proliferative disease inherent in immunosuppression are simply too great. Moreover, the society adds, the mere survival of the graft is no measure of success.
Even when a person’s own hand is successfully reattached half the normal function is lost, says the Mayo Clinic’s Dr. William Cooney, president-elect of the society. He thinks hand transplantation makes a non-life-threatening condition potentially life-threatening.
Yet a University of Louisville team led by Dr. John Barker has IRB approval for 20 upper-extremity transplants and expects to do the first soon.
The group’s research with pigs, using FK506, myocophenolate mofetil, and prednisone, led to a success rate of 75% to 90%, and it will use the same regimen orally for its initial patients. All candidates got psychological screening, says Dr. Barker, and they must have made an effort to use a prosthesis.
In Lyon, France, the Australian patient was discharged 24 days after a right hand and forearm was transplanted at Herriot Hospital to replace the extremity lost to a chain saw. Four skin biopsies revealed no rejection, says Dr. Xavier Martin. -Elsie Rosner
ROSEMONT, Ill.-Despite the early success of a hand transplant in France, a U.S. specialty group has given a thumbs-down to the procedure.
