RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/ijps.IJPS_96_17
First two bilateral hand transplantations in India (Part 4): Immediate post-operative care, immunosuppression protocol and monitoring
Publikationsverlauf
Publikationsdatum:
09. Juli 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00042863/201702/lookinside/thumbnails/10-4103-ijps-ijps_96_17_00168-1.jpg)
ABSTRACT
Introduction: Being able to counter immune-mediated rejection has for decades been the single largest obstacle for the progress of vascular composite allotransplantation (VCA). The human immune system performs the key role of differentiating the ‘self’ from the ‘non-self’. This, although is quintessential to eliminate or resist infections, also resists the acceptance of an allograft which it promptly recognises as ‘non-self’. Materials and Methods: Pre-operative evaluation of the recipient evaluation included immunological assessment in the form of panel reactive antibodies (PRA), human leucocyte antigen (HLA) typing, donor-specific antibody detection assays (DSA) and complement-dependent cytotoxicity assays (CDC). Induction immunosuppression was by thymoglobulin and the maintenance by the standard triple-drug therapy. Results: Both the recipients were managed by the standard triple drug therapy and have had only minor episodes of rejections thus far which have been managed appropriately. Discussion: Induction immunosuppression was by thymoglobulin and the maintenance by the standard triple-drug therapy. Various groups have tried various other formulations and regimes as well. Conclusion: A comprehensive plan has to be drawn up for immunological screening, selection and the post-operative immunosuppressant usage. The ultimate goal of these immunosuppression modalities is to achieve a state of donor-specific tolerance.
-
REFERENCES
- 1 Cendales LC, Kanitakis J, Schneeberger S, Burns C, Ruiz P, Landin L. et al. The Banff 2007 working classification of skin-containing composite tissue allograft pathology. Am J Transplant 2008; 8: 1396-400
- 2 Ashvetiya T, Mundinger GS, Kukuruga D, Bojovic B, Christy MR, Dorafshar AH. et al. Donor-recipient human leukocyte antigen matching practices in vascularized composite tissue allotransplantation: A survey of major transplantation centers. Plast Reconstr Surg 2014; 134: 121-9
- 3 Breidenbach WC, Gonzales NR, Kaufman CL, Klapheke M, Tobin GR, Gorantla VS. et al. Outcomes of the first 2 American hand transplants at 8 and 6 years posttransplant. J Hand Surg Am 2008; 33: 1039-47
- 4 MacKay BJ, Nacke E, Posner M. Hand transplantation. A review. Bull Hosp Jt Dis 2014; 72: 76-88
- 5 Brandacher G, Gorantla VS, Lee WP. Hand allotransplantation. Semin Plast Surg 2010; 24: 11-7