Upper extremity transplantation: The massachusetts general hospital experience

Since the first successful hand transplantation performed in 1998 in France, the optimization of immunosuppressive regimens and refinements of surgical techniques have allowed vascularized composite allotransplantation to emerge as a valuable and promising therapeutic option for amputees. However, such procedure can only be envisaged by a multidisciplinary team and requires extensive training prior to surgery. The program for vascularized composite allotransplantation at the Massachusetts General Hospital was started in 2010, and the first unilateral upper extremity allotransplantation in Massachusetts was performed in October 2012. In this chapter the authors first outline how the team intensively practiced for 2 years to prepare for the surgery, through multiple cadaver rehearsals and planning sessions. An overview of the organization of the entire transplantation process is then described, from obtaining the necessary IRB approvals to the day of surgery. Recipient and donor characteristics, surgical technique, outcomes, and lessons learned from this case are also discussed. Finally, a brief introduction is made on the state of research on vascularized composite allotransplantation, mostly focused on the development of tolerance induction protocols through tissue engineering and machine perfusion systems.