Bilateral Trans‐humeral Arm Transplantation: Result at 2 Years

Unilateral and bilateral hand transplantations have been performed worldwide with good mid‐term functional results. An above‐elbow bilateral transplantation was performed in a 29‐year‐old male patient from a fully HLA‐mismatched donor. Alemtuzumab induction and steroid‐free maintenance immunosuppression with tacrolimus and mycophenolate was used. Due to acute rejection, steroids were introduced at 6 months. Three acute rejection episodes occurred, one treated with alemtuzumab. New‐onset diabetes after transplant, dyslipemia and worsening of previous high blood pressure required treatment. At 26 months post‐transplantation, the patient has excellent elbow active movement, active flexion and extension of the thumb and fingers, useful sensation and a gainful job. Based on the functional results of the case reported, bilateral trans‐humeral transplantation could be a viable treatment for selected bilateral above‐elbow amputees.