RisksBy Mayo Clinic staff
A hand transplant is a major operation and carries all the risks typical of transplant surgery, including infection, bleeding and blood clot formation (thrombosis). A clot would cause decreased blood flow to your hand, a serious complication that would need immediate surgery to repair.
Rejection of a donor hand happens when your body's immune system sees your donor hand as foreign to your body. Like viruses or bacteria, your immune system will then try to destroy your donor hand. Rejection can happen two ways:
Acute rejection. Acute rejection happens when your immune system tries to quickly destroy the tissues in your donor hand. It can also happen when your immune system sends special protein (antibodies) to attack blood vessels and tissues in your donor hand.
If you have acute rejection, you may notice a rash, swelling or change in skin color of your hand or arm. You may or may not have pain.
Acute rejection can be controlled with medications, but in rare cases, you may need to have your donor hand or hands removed. Having a previous acute rejection doesn't disqualify you from having another hand transplant, but it may make it more difficult to match you with a donor.
- Chronic rejection. Chronic rejection happens over a longer period of time. Your hand may become painful and lose function. You may notice a loss of hair on your hand or changes in your fingernails.
You should report any changes in the appearance or sensation in your hand to your transplant team. You should be taught to watch for early signs of rejection. If your transplant team suspects your body is rejecting your donor hand, you may need to begin taking more anti-rejection medications. Your transplant team will likely order tests to be done on your hand, including a biopsy of the tissue in your donor hand.
Immunosuppressants are medications you take to prevent your body from rejecting your donor hand or hands. Immunosuppressants are powerful medications that you will need to take for the rest of your life as long as you have the donor hand. Major side effects of immunosuppressants include:
- Increased risk of serious infections, including cytomegalovirus (CMV)
- Increased cancer risk
- Kidney damage
- Increased risk of developing diabetes
- Increased cholesterol risk
Less serious immunosuppressant side effects include:
- Weight gain
- Hair loss
- Barbara Woodward Lips Patient Education Center. Hand and arm transplantation. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2010.
- Information for potential hand transplant patients. Composite Tissue Allotransplantation. http://www.handtransplant.com/TheProcedure/InfoforPotentialPatients/tabid/103/Default.aspx. Accessed Jan. 12, 2011.
- Petruzzo P, et al. The International Registry on Hand and Composite Tissue Transplantation. Transplantation. 2010;90:1590.
- Lanzetta M, et al. Second report (1998-2006) of the International Registry of Hand and Composite Tissue Transplantation. Transplant Immunology. 2007;18:1.
- Kaufman CL, et al. A new option for amputees: Transplantation of the hand. Journal of Rehabilitaion Research and Development. 2009;46:395.
- Cendales L, et al. Implementation of vascularized composite allografts in the United States: Recommendations from the ASTS VCA Ad Hoc Committee and the Executive Committee. American Journal of Transplantation. 2011;11:13.