Purpose of the study: The purpose of this work was to report our experience with three patients who underwent hand transplantation procedures following traumatic amputations.

Material and methods: The three patients underwent surgery in 1998, 2000, and 2003. One hand was transplanted in one patient and two in two patients. The technical principles of autologous macro-re-implantations were applied. The re-implantation level was the forearm in all cases. Medical treatment prescribed for life was similar to treatments currently used for renal transplantation (tacrolimus, mofetil mycophenolate and prednisolone).

Results: After an apparent initial success, the first transplanted patient (one hand) had to be re-amputated 2.5 years later due to poor tolerance and poor treatment observance. For the two patients transplanted (two hands for both) in 2000 and 2003, the functional outcome in terms of recovered sensitivity (tact), motricity, and function were quite satisfactory in light of the handicap of bilateral amputation. Immunosuppressor treatment was well tolerated at 1.5 and 4.5 years respectively.

Discussion: Due to the lack of prior experience reported in the literature, we examined the risk-benefit ratio of these re-implantations which must still be considered as clinical experimentation. It is important to consider the potential benefit of myoelectric prostheses as well as the known complications related to immunosuppressor treatments. Patient motivation is also an important factor to consider.

Conclusion: These three cases demonstrate that the outcome of orthopedic composite tissue allografts in patients given immunosuppressor therapy is quite variable at less than four years follow-up. Experience with a larger number of patients will be necessary before broadening potential indications.