Extending the boundaries of transplantation

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7401.1226 (Published 05 June 2003) Cite this as: BMJ 2003;326:1226

Recent hand transplants may herald a new era

  1. Shehan Hettiaratchy (shehan.hettiaratchy@tbrc.mgh.harvard.edu), fellow,
  2. Peter E M Butler (p.butler@rfc.ucl.ac.uk), consultant plastic surgeon
  1. Division of Plastic Surgery/Transplantation Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston MA 02114, USA
  2. Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London NW3 2QG

    Solid organ transplantation has been one of the most striking medical success stories of the past 50 years. Today even the most complex cardiac transplants are viewed as routine, although it is only 35 years since the first successful heart transplant was performed. One of the main reasons for this success is the introduction of new more specific immunosuppressants that have improved our ability to control the transplant patient's immune response. This has reduced the incidence of acute graft loss and the side effects of immunosuppressive regimens. These factors have led some transplant teams to suggest that transplantation should no longer be reserved for life threatening conditions but be used for any problem that can be solved with allogenic tissue. Citing this rationale, surgeons have begun using cadaveric tissue to reconstruct structural, non-life threatening defects of the human body. Over the past five years 20 hand transplants and a laryngeal transplant have been successfully carried out.1 2 Others have transplanted knees, nerves, and even the flexor tendon apparatus of the hand.35 However, reconstructive transplantation is very different from other forms of transplantation. Whether it is appropriate at the present time is the subject of debate.

    Reconstructive transplantation differs from other forms of transplantation in numerous ways. It is performed in healthy patients who have a normal life expectancy; they do not have a chronic …

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