Upper Extremity Transplantation: The Polish Experience

Jerzy Jablecki, St. Hedwig Hospital, Trzebnica, Poland.

The goal of this study is the presentation of the experience of the Center after 5 years of activity.

Qualification and waiting list. Creating the “waiting list of would-be hand recipients” we adhered the following inclusion criteria implemented by Lanzetta [3], Schneeberger and Brandacher [4,5] and others: age comprised between 18 and 55 years, dominant hand or bilateral upper limbs after traumatic amputation at any level below mid-arm, tried and refused different prosthetic alternatives, otherwise healthy and mentally sane, able to give an informed consent, resident in the country, available to follow-up, with the support of his/her family and local medical practitioners.

A total number of 68 possible candidates were seen over a 5 years period, and according to the selection process and inclusion criteria 15 patients were thought to be preliminary candidates for a HTx. These 15 patients proceeded to a formal hospital admission after signing the detailed informed consent, in order to sustain a detailed evaluation including invasive diagnostic tests (i.e. full blood tests, MRI, psychology tests, muscle and sensory evaluation, ultrasound, HIV and HCV tests). These group consist of 13 M (aged 21 - 55) with single, dominant had amputation and two females (aged 18, 23) with both hands amputation. A growing number of patients are currently undergoing screening for transplantation and those selected for transplantation will be waitlisted in the near future.

In the process of donor acquisition we cooperated with the National Center for Tissue Transplantation “Poltransplant”. Sadly, only 7 hospitals provided our Subdepartment with donor notifications, with the great majority from one centre (6 notifications, 3 of which eventually led to transplantation), Our transplant program encountered 10 resignations, markedly 4 of which were on patients’ request, and the remainder due to blood-group incompatibility (5 cases), limb size (3) and donor’s neoplasm diagnosed at the very last moment prior to procurement (chorionepithelioma). Within this group 7 HTx were performed in 6 men aged 32, 42, 29, 30, 33, 50 in the following years: 2006 (mid-forearm level), 2007 (mid-forearm level), and in 2008 (distal forearm level) , 2009 (distal arm level ), 2010 (double HTx , wrist level), 2011 (wrist level) ; and in 2010 one woman aged 56 (mid-arm level).