REQUIREMENTS OF THE CANDIDATES:
- Bilateral amputation of hands, as traumatic as others. In congenital causes only consider the of-age patients. In medical reasons, you must provide renal function studies.
- Age; Between 18 and 50 years.
- Living in Spain and be covered by the National Health System.
- Not being a smoker. Not overweight. No diabetes. No ischemic heart disease (heart attack).
- Must be willing to start a surgical procedure and rehabilitation of at least two years.
- It is necessary to reside in the city of Valencia (Spain), for at least 8 months after transplantation, and later in Spain, while keep the transplanted hands.
- Absence of major diseases, especially tumors, over the past 10 years.
- Must be willing to receive anti-rejection medication while you keep the hands, and even medical countermanded.
BASIC STUDY TO BE PRESENTED BY CANDIDATES MEETING ALL PREVIOUS REQUIREMENTS:
- Blood group.
- Viral Serology: HBV, HCV, HIV.
- Viral Serology: CMV, EBV.
- Biochemistry: glucose, urea, creatinine.
- Psychiatric report, which specifies that the candidate does not present any process that contraindicate transplantation.
- Lymphocytotoxic antibodies (anti-HLA)
BASIC INFORMATION ON THE ANTIRREJECTION MEDICATION (IMMUNOSUPPRESIVE TREATMENT):
The candidate will be informed of the anti-rejection medication required during the years the duration of the transplant. This medication can not stay, and is subject to strict medical supervision.
TACROLIMUS: calcineurin inhibitor that inhibits the IL-2. Its main side effects are:
- Hypertension: maybe its appearance, requiring antihypertensive treatment until the voltages are well controlled. Sometimes you need to keep their keeping while the transplant. .
- Hyperglycemia: its toxic effect at pancreatic, causes increased blood glucose. Often be corrected with medication, which is necessary for several weeks.
- Chronic renal failure occurs gradually and cumulatively over the months and years. When removing the medication only partially restored. To avoid the need to avoid NSAIDs, and maintain adequate hydration, drinking at least three liters of water a day.
- Neurotoxicity: manifested by tremors and headaches. Are rare and reversible.
- This drug interacts with many drugs. The introduction of new drugs should be reviewed by our medical team.
- Drug blood levels measurements are needed weekly to achieve the desired levels, intermediate between avoiding rejection and minimize the risk of side effects.
MYCOPHENOLATE MOFETIL: Acts by inhibiting the metabolism of inosine. Its main side effects are:
- Gastrointestinal complaints, which are controlled by dietary measures and medication occasionally.
- Risk of blood proliferative disorders: 1% of leukemia in patients with transplanted kidney. Has not been observed in patients with transplanted hands.
- Severe esophagitis, observed in 5% of transplanted kidneys, and associated with CMV infection (CMV).
CORTICOSTEROIDS: inhibit dendritic cells, which are the most potent antigen-presenting. Its main side effects are:
- Fluid retention wight gain.
- Hypertension.
- Hyperglycemia.
- Osteoporosis and hip fracture. Observed in one time after a hand transplant. Requiring surgical intervention.
ALEMTUZUMAB: a genetically modified antibody that depletes lymphocytes, and prevents the rejection between 3 and 9 meses.Sus main adverse effects are the reactivation of CMV, thyroiditis and serum sickness.
These drugs were designed to prevent rejection in solid organ transplant (kidney, heart, liver, etc). The use of these drugs for the transplantation of hands on a large scale has not been authorized by the Ministry of Health. Its use is possible only with the written consent of the patient, the so-called "compassionate use." The signing of the compassionate use of this medication the patient is known that these drugs were designed for other purposes, which at the moment is to rely on them as there are no other ways to prevent rejection, and assuming the risks arising from the use of these drugs.
The use of this medication has kept in good condition 100% of the hand transplants performed in Europe and the U.S.. The risk of rejection episodes is 1.5 episodes per year during the first 2 years. Subsequently, the risk decreases, and there has been no rejection episodes within 4 years. During the post-transplant period, both short and long term, we try to reduce the medication to avoid side effects while maintaining the patient free of rejection.
After discharge, the transplant recipient must reside in the city of Valencia, for intensive rehabilitation treatment and tends to close the medical team. CMV controls were carried out for several weeks and tacrolimus.
The emergence of a suspected rejection episode required immediately move to the Hospital Universitario "La Fe" to proceed to the entry and biopsy under local anesthesia, and increased medication. After inspecting the rejection, the patient will be discharged, requiring new weekly checks of drug levels in blood.
Reactivation of cytomegalovirus (CMV) has been observed in patients with anti-rejection treatment. It is important to know whether the infection was before the transplant. CMV infection requiring hospitalization and treatment since the onset of CMV is highly associated with the onset of rejection.
Once known and assumed the risks of medication, a study was carried out preoperatively in the Hospital Universitario "La Fe" of Valencia. After checking that there are no medical contraindications, the patient will be included on the waiting list for transplantation.
FOR MORE INFORMATION PLEASE CONTACT US. RECEIVER WILL BE EVALUATED AND MORE INFORMATION WILL BE PROVIDED IN FURTHER INTERVIEWS.
WE WILL TAKE INTO CONSIDERATION ONLY BILATERAL AMPUTEE PATIENTS.
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