Hand Transplantation

Vascularized composite allotransplantation or reconstructive transplantation is an emerging new era in transplant medicine and has become a viable reconstructive option for patients with large and devastating tissue defects. Advances in microsurgical techniques, transplant immunology, and the development of potent immunosuppressive agents have enabled the realization of such types of transplants. Over the past two decades, a rapidly growing number of hand and upper extremity transplantations have been performed worldwide with highly encouraging results, thus providing many recipients with significant functional improvements. In this chapter we will review the functional and immunological outcomes based on the world experience, discuss indications and surgical technical aspects of hand transplantation, and provide an outlook on novel concepts for immune modulation and tolerance induction.