Eira Sofi Roth MD, Presenter: Nothing to Disclose

Vijay Saradhi Gorantla MD, PhD, Abstract Co-Author: Nothing to Disclose

Cynthia Ann Britton MD, Abstract Co-Author: Nothing to Disclose

Joseph Losee MD, Abstract Co-Author: Nothing to Disclose

David George Buck MD, Abstract Co-Author: Nothing to Disclose

To review the role of imaging from screening and selection through surveillance in human hand transplantation based on the largest single center experience in the United States.

A systematic review of all imaging obtained over a three-year period in 5 patients receiving 8 hand/forearm transplants at the University of Pittsburgh during the pre-intra-and post-operative phases. Findings from various modalities were used to confirm candidacy and correlated with clinical, immunologic, functional and graft survival outcomes in recipients. A combination of plain radiography, MRI and conventional angiography was used to determine anatomical integrity of the recipient stump pre-transplant and for surgical planning. Plain radiography was used to monitor bone healing and high frequency ultrasound (30-70 Mhz) was used to evaluate for graft vasculopathy due to chronic rejection.

Five patients were selected for transplantation from over 30 patients screened for eligibility based on criteria that included both clinical and imaging information. Follow up plain radiography revealed atrophic or hypertrophic nonunion in the ulnae of 2/5 subjects which responded to bone stimulation and/or revision surgery. One patient required tenolysis and imbrication after surgery to improve function. There was no evidence of luminal narrowing/occlusion in small/medium sized arteries on surveillance angiography or intimal hyperplasia/vasculopathy on ultrasound biomicroscopy after transplantation in any patient.

Imaging is an important tool in the evaluation of eligible candidates as well as in monitoring for efficacy and quality of outcomes after hand transplantation. We used radiography, angiography, MR and ultrasound to evaluate neurovascular, muscular and osseous integrity before, during and after transplantation. The findings were key to appropriate selection as well as surgical planning and follow up management and monitoring in hand transplant recipients. The insights gained will enable development of an imaging algorithm including conventional and innovative approaches that improve outcomes after these life enhancing reconstructive procedures.

All aspects of hand transplantation depend on imaging, however no unified consensus on proper imaging usage exists, thus we share our observations at the largest hand transplant center in the USA.

Roth, E, Gorantla, V, Britton, C, Losee, J, Buck, D, The Role of Imaging in Patient Selection, Preoperative Planning, and Postoperative Monitoring after Human Upper Extremity Allotransplantation.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034264.html