Abstract

LANDIN-JARILLO, Luis; BONASTRE-JULIA, Jorge; BOLADO-GUTIERREZ, Pedro  and  JIMENEZ-MARTIN, Carlos. Safety and effectiveness of lymphocyte depletion in hand transplantation. Cir. plást. iberolatinoam. [online]. 2017, vol.43, suppl.1, pp.s87-s96. ISSN 1989-2055.

Background and Objective. Composite tissue allotransplantation is usually indicatedwhen no reconstructive option is available and allogenic reconstruction becomes the only feasible treatment. Patients receiving a composite tissue allotransplant require chronic immunosuppression,which expose them to certain risks. Despite the administration of triple immunosuppressive therapy, these patients are at risk of suffering acute rejection (AR), whose usual treatment includes therapy adjustment, corticoid boluses and topical administration of immunosuppressive drugs, although the more severe cases may require lymphocyte depletion. In this study we report the safety and effectiveness of antithymocyte globulin (ATG) as rescue treatment for a steroid-resistant AR episode. Methods. We conducted systematic review of complications after administration of ATG, including 108 publications about 57 patients. We also report on a case of bilateral arm transplantation in whomATG was used after a steroid-resistant AR episode. Results. ATG was mainly used as induction therapy, and also to control steroid-resistant AR episodes in 5 patients. All patients that had received ATG successfully responded,but ATG did not prevent further rejection episodes except for 1 patient. Our patient presented a grade III episode of acute cellular rejection according to the Banff scale, treated unsuccessfully with 2 courses of methylprednisolone. On day 50 and 57 post-transplantation ATG was given and the rejection successfully responded, and after 450 days of follow-up the patient remained free of rejection. At the moment the patient has not experienced any complications related to ATG. Conclusions. The treatment of steroid-resistant AR episodes in composite tissue allotransplantation can be successfully performed administrating ATG. All cases described in the literature responded favorably to ATG as was the case treated in our center.

Keywords : Transplant; Hands; Composite tissues; Acute rejection; Thymoglobulin.

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