Correlation Engine 2.0
Clear Search sequence regions

  • adult (1)
  • allografts (1)
  • antibodies (1)
  • antigens (3)
  • case (1)
  • cellular (1)
  • class ii antigens (4)
  • donor (3)
  • female (2)
  • graft (2)
  • HLA (7)
  • humans (1)
  • organ transplants (1)
  • patient (3)
  • rapamycin (1)
  • tacrolimus (3)
  • thymoglobulin (1)
  • transplant (4)
  • upper limb (1)
  • woman (1)
  • Sizes of these terms reflect their relevance to your search.

    Vascularized composite allografts may be more susceptible to rejection than other types of organ transplants, particularly in sensitized recipients. We describe a successful transatlantic bilateral hand transplant in a 40-year old woman who was highly sensitized to class II HLA antigens including HLA-DPB1 (UNet CPRA = 86%). Prior to transplantation, we selected an upper limb donor based on HLA class II matching and absence of donor specific antibodies, given evidence that class II mismatches are associated with acute cellular rejection in hand transplants. The patient was conditioned using five doses of thymoglobulin, and her immunosuppression included tacrolimus, rapamycin, mycophenolate, and prednisone. Post-transplant, the patient non-DSA anti-HLA antibody levels drastically increased, but only transiently and weak DSAs developed, which became undetectable by two months posttransplant. Following transplantation, periodic biopsies over 6 months indicated no evidence of rejection except for transient Banff grade 1 and one sample with grade 2 acute rejection. There was no evidence of rejection on her recent 1-year follow-up. The patient is currently healthy, has recovered protective sensibility, and is regaining excellent function. This case highlights the importance of pre-transplantation planning, donor selection/compatibility, and ethical considerations in the ultimate success of VCA. Copyright © 2021 Elsevier B.V. All rights reserved.


    Saïd C Azoury, F Bradley Johnson, Matthew Levine, Stephanie Veasey, Christine McAndrew, Abraham Shaked, Laurent Lantieri, Malek Kamoun, L Scott Levin. Successful transatlantic bilateral hand transplant in a young female highly sensitized to HLA class II antigens. Transplant immunology. 2021 Apr;65:101377

    Expand section icon Mesh Tags

    Expand section icon Substances

    PMID: 33610677

    View Full Text