317.4: Bilateral Hand Transplantation at a Tertiary Care Centre in India

Objective: To assess the outcomes of 11 hand transplant patients who underwent transplant at Amrita institute of medical sciences, Kochi, India. Materials and methods: This is a retrospective, cross sectional observational analysis of 11 hand transplant patients who underwent hand transplant at Amrita institute of medical sciences, Kochi, India. Results: 11 patients underwent hand transplant from 2015 to 2022. All patients received bilateral hand transplant. Average age at transplant was 31years (24yrs to 52 yrs). The mean follow-up of these patients were 2yrs. The cause of hand loss was due to electrical burns (n=5); crush injury (n=4) and blast(n=2). All patients were induced with ATG and maintenance immunosuppression was tacrolimus, mycophenolate mofetil and prednisolone. The average cold ischaemia time was 320 minutes for each limb and the average warm ischaemia time was 15 minutes. 7 out of the 11 patients had at least one episode of rejection (all were acute cellular rejection). The average number of rejection was 2.5 episodes. Rejection occurred within the first two months. Most rejections were successfully treated with steroids. One patient alone received IVIG and rituximab for rejection but never occurred again. The infectious complications noted were CMV colitis (n=1), herpes labialis (n=1), Giardiasis (n=1). One patient developed monomorphic B cell lymphoma of the gastrointestinal tract which was successfully treated with Rituximab and cure was attained. One of them had graft loss and amputated one limb and one patient expired due to complications of sepsis. Rest all were functional. Conclusions: Hand transplant’s long term functional status remains good. With advances in immunosuppression and treatment for the complications this can be offered to a wider population.