Introduction. Hand transplantation is a source of controversy. Functional recovery and improved quality of life must be weighed against the risk of immunosuppression and chronic allograft rejection.

Materials and Methods. On June 15th, 2002, we transplanted the right distal 1/3 forearm of a 27-year old brain-dead man to a 22-year old male patient who lost his right dominant hand in a work accident. The donor hand matched for size and skin tone and 3/6 HLA. Immunosuppression included antithymocyte globulins as induction therapy and tacrolimus, mycophenolic acid and prednisolone as induction and maintenance therapy. One year postoperatively a flexor tendon tenolysis and shortening was performed. Follow-up consists of skin biopsies, functional MRI, routine post-transplant laboratory tests, psychological support and intensive physiotherapy.

Results. At 20 months postoperatively, there has been no clinical evidence of rejection and no infectious complications have occurred. The patient perceives hot and cold and can localize touch at the fingertips. There is motor return of the transplanted intrinsic muscles. Most activities of daily life are possible; functional tests show the transplanted hand to be superior to his preoperative myoelectric prosthesis. Functional MRI shows progressive cortical reorganization. The general appearance is very good with satisfactory nail growth.

Discussion. This young patient tolerates well his immunosuppression. Rejection of the transplanted hand has not occurred and daily tasks are better performed than with his prosthesis. Moreover the psychological impact of even a poor sensibility may not be underestimated. However hand transplantation is still experimental and little is known about the long-term.