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Kim YH, Choi YR, Joo DJ, Baek WY, Suh YC, Oh WT, Cho JY, Lee SC, Kim SK, Ryu HJ, Jeon KO, Lee WJ, Hong JW. Reaching New Heights: A Comprehensive Study of Hand Transplantations in Korea after Institutionalization of Hand Transplantation Law. Yonsei Med J 2024; 65:108-119. [PMID: 38288651 PMCID: PMC10827641 DOI: 10.3349/ymj.2023.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE With the revision of the Organ and Transplantation Act in 2018, the hand has become legal as an area of transplantable organs in Korea. In January 2021, the first hand allotransplantation since legalization was successfully performed, and we have performed a total of three successful hand transplantation since then. By comparing and incorporating our experiences, this study aimed to provide a comprehensive reconstructive solution for hand amputation in Korea. MATERIALS AND METHODS Recipients were selected through a structured preoperative evaluation, and hand transplantations were performed at the distal forearm level. Postoperatively, patients were treated with three-drug immunosuppressive regimen, and functional outcomes were monitored. RESULTS The hand transplantations were performed without intraoperative complications. All patients had partial skin necrosis and underwent additional surgical procedures in 2 months after transplantation. After additional operations, no further severe complications were observed. Also, patients developed acute rejection within 3 months of surgery, but all resolved within 2 weeks after steroid pulse therapy. Motor and sensory function improved dramatically, and patients were very satisfied with the appearance and function of their transplanted hands. CONCLUSION Hand transplantation is a viable reconstructive option, and patients have shown positive functional and psychological outcomes. Although this study has limitations, such as the small number of patients and short follow-up period, we should focus on continued recovery of hand function, and be careful not to develop side effects from immunosuppressive drugs. Through the present study, we will continue to strive for a bright future regarding hand transplantation in Korea.
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Affiliation(s)
- Yo Han Kim
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
- Organ Transplantation Center, Severance Hospital, Seoul, Korea
| | - Dong Jin Joo
- Organ Transplantation Center, Severance Hospital, Seoul, Korea
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Yeol Baek
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Young Chul Suh
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Won Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Yong Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kyum Kim
- Department of Diagnostic Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyang Joo Ryu
- Department of Diagnostic Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Ock Jeon
- Organ Transplantation Center, Severance Hospital, Seoul, Korea
| | - Won Jai Lee
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Hong
- Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
- Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
- Organ Transplantation Center, Severance Hospital, Seoul, Korea.
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Woo SH, Kim YW, Cheon HJ, Jang S, Do JY, Choi JH, Kang DH, Nam HJ, Yoo MJ, Lee YS, Choi JH. Process of Obtaining Social Consensus and 3-Year Functional Outcomes of the First Hand Allotransplantation in Korea. J Korean Med Sci 2021; 36:e6. [PMID: 33429470 PMCID: PMC7801147 DOI: 10.3346/jkms.2021.36.e6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/27/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND On February 2, 2017, the surgical team of ten board-certified hand specialists of W Hospital in Korea successfully performed the nation's first hand transplantation at Yeungnam University Medical Center (YUMC). This paper reports on the legal, financial, and cultural hurdles that were overcome to open the way for hand transplantation and its functional outcomes at 36 months after the operation. METHODS W Hospital formed a memorandum of understanding with Daegu city and YUMC to comply with government regulations regarding hand transplantation. Campaigns were initiated in the media to increase public awareness and understanding. With the city's financial and legal support and the university's medical cooperation, a surgical team performed a left distal forearm hand transplantation from a brain-dead 48-year-old man to a 35-year-old left-handed man. RESULTS With this successful allotransplantation, the Korean Act on Organ Transplantation has now been amended to include hand transplantation. Korean national health insurance has also begun covering hand transplantation. Functional outcome at 36 months after the operation showed satisfactory progress in both motor and sensory functions. The disabilities of the arm, shoulder, and hand score were 23. The final Hand Transplantation Score was 90 points. Functional brain magnetic resonance imaging shows significant cortical reorganization of the corticospinal tract, and reinnervation of intrinsic muscle is observed. CONCLUSIONS Hand transplantation at the distal forearm shows very satisfactory outcomes in functional, aesthetical, and psychological aspects. Legal and financial barriers against hand transplantation have long been the most burdensome issues. Despite this momentous success, there have been no other clinical applications of vascularized composite allotransplantation due to the limited acceptance by Korean doctors and people. Further public education campaigns for vascularized composite allotransplantation are needed to increase awareness and acceptance.
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Affiliation(s)
- Sang Hyun Woo
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea.
| | - Young Woo Kim
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
| | - Ho Jun Cheon
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
| | - SungHo Jang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong Ho Kang
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
| | - Hyun Jae Nam
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
| | - Myung Jae Yoo
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
| | - Young Seok Lee
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
| | - Jin Hee Choi
- W Institute for Hand & Reconstructive Microsurgery, W General Hospital, Daegu, Korea
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Lim JW, Eun SC. Hemifacial Transplantation Model in Rats. Arch Craniofac Surg 2014; 15:89-93. [PMID: 28913197 PMCID: PMC5556820 DOI: 10.7181/acfs.2014.15.2.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/23/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022] Open
Abstract
Background To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. Methods Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. Results The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). Conclusion The rat hemifacial transplantation model is suitable as a standard transplantation training model.
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Affiliation(s)
- Jong Woo Lim
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea
| | - Seok Chan Eun
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea
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