[Three lessons learned from the first double hand transplantation].

The first double hand transplantation was performed in Lyon in a 33 year-old recipient with bilateral amputation following an explosive handling accident. At 2 years, the global and the functional results were considered as very satisfactory. Three aspects are presented in this article: (1) immunosuppressive protocol was efficient and well tolerated. Only 2 skin rejection episodes on post operative days 53 and 82 were easily reversed with an increase in Prednisone doses and local applications of steroid cream; (2) successive functional magnetic resonance imaging demonstrated a global remodelling of the limb cortical map and a reversal of the functional reorganisation induced by amputation; (3) the psychological appropriation of "alien" hands improved with time. These grafts, permanently visible by the patient and others, induced a psychic defence mechanism: "denial", a lack of perception of some features of reality or a perception of reality that is immediately neglected or rejected. Denial tended to lessen as the new grafted hands gained in sensitivity and motricity.