Functional outcomes and innovations in hand transplantation: A systematic overview of the past decade

Vascularized composite allotransplantation (VCA), including hand transplantation, provides a unique opportunity to overcome the defective functions of traumatic transamputees and fill the gaps of congenital limb deficiencies. From 2015 to 2025, advancements in hand transplantation techniques have been evaluated in reviews synthesizing functional outcomes: motor recovery (DASH scores averaging 20–30 points), sensory recovery (s-2PD <10 mm in 70% of recipients after two years), and psychosocial improvements (e.g., higher SF-36 scores). Microsurgical improvement, achieved through precise nerve coaptation and the minimization of immunosuppression with alemtuzumab and thymoglobulin, has led to more than 150 transplants since 1998, with rejection rates limited to 27.9 per cent. Innovations in the drug rehabilitation process, such as biofeedback and virtual reality, enhance the process of cortical reintegration. Advancements in bioengineering, including the use of decellularised nerve allografts and mesenchymal stem cells, offer a method for regenerating nerve tissue and reducing the need for immunosuppression. Difficulties continue to persist, such as graft loss (10.8%), chronic rejection and complications caused by immunosuppression (e.g. renal dysfunction, infections). Discrimination in access around the world has become another priority; however, ethical issues, including fair patient selection and informed consent, continue to be of concern. This systematic review highlights the need to create standard outcome measures and international registries to streamline clinical practices. With the removal of immunological, ethical, and accessibility barriers, hand transplantation will become a reality that improves outcomes for patients worldwide.