The study was conducted to assess serious infectious complications in five hand allograft recipients (four males, one female, age 40 ± 10 years), transplanted between 2006 and 2010. All donors and recipients were positive but one for cytomegalovirus (
CMV) immunoglobulin G. All recipients received immunosuppressive therapy
basiliximab,
tacrolimus,
mycophenolate mofetil and
methylprednisolone. Until May 2013, there were four cases of severe
infections requiring hospitalization. One patient developed CMV
infection on the 28th postoperative day. Despite
therapy with
ganciclovir and prophylaxis with
valganciclovir,
reinfection episodes occurred both 4 weeks and 7 months later. The female recipient developed CMV
infection 8 months after
hand transplantation. After 3 weeks of
ganciclovir treatment, the polymerase chain reaction results remained negative. We found that the CD4/CD8 T lymphocytes ratio differs in those two patients who had developed CMV disease in the past in comparison to the three remaining hand transplant recipients (mean 0.46 versus 1.7, respectively). Moreover, the ratio of patients who were CD4-8 negative to total T lymphocytes in CMV recovered patients was two-fold higher compared to the remaining recipients (10.0 versus 4.4, respectively). The female recipient was also hospitalized because of acute
tonsillitis 25 months after
hand transplantation, and successfully treated with
amoxicillin clavulanate. The third recipient was hospitalized because of severe
acute pain involving right lower limb, especially foot, 74 months after
hand transplantation. After 48 hours, a painful vesicular
rash occurred on the plantar as well as dorsal surface of right foot and
herpes zoster was diagnosed. Immunosuppressive therapy after
hand transplantation may be complicated by serious
infections. CMV disease was associated with persistent alterations in T lymphocyte subsets.