Hand transplant is a treatment option for people who have had one or both hands amputated. In a hand transplant, you receive one or two donor hands and a portion of the forearms from a person who has died. Hand transplants are specialized procedures performed in only a few transplant centers worldwide.
Although not guaranteed, a hand transplant may help you regain some hand function and sensation. While a hand transplant can improve your quality of life, it is a lifelong commitment to treatment. You'll need to take special medications (immunosuppressants) and have routine physical therapy and doctor appointments to check on the condition of your donor hands.
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A hand transplant is performed in selected cases in an attempt to improve quality of life and give you some function and sensation in your new hands.
When matching you with a donor hand for a hand transplant, surgeons consider:
-Comparable ages of donor and recipient
-Same sex between donor and recipient
Hand transplant is a treatment option for people who have had one or both hands amputated. In a hand transplant, you receive one or two donor hands and a portion of the forearms from a person who has died. Hand transplants are specialized procedures performed in only a few transplant centers worldwide. Over the last five years, there have been 14 confirmed hand transplants; two transplants have been removed.
More than 85 patients have received hand/arm transplants at institutions around the world. The longest surviving hand/arm transplant is the first U.S. recipient at 11 years.
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A hand transplant is a major operation and carries all the risks typical of transplant surgery, including infection, bleeding and blood clot formation (thrombosis). A clot would cause decreased blood flow to your hand, a serious complication that requires immediate surgery to repair.
Rejection of a donor hand happens when your body's immune system treats your donor hand as foreign to your body. Like invading viruses or bacteria, your immune system will then try to destroy your donor hand. Rejection can happen two ways:
Acute rejection. Acute rejection happens when your immune system tries to quickly destroy the tissues in your donor hand. It can also happen when your immune system sends special proteins (antibodies) to attack blood vessels and tissues in your donor hand.
If you have acute rejection, you may notice a rash, swelling or change in skin color of your hand or arm. You may or may not have pain.
Acute rejection usually can be controlled with medications, but in rare cases, you may need to have your donor hand or hands removed. Having a previous acute rejection doesn't disqualify you from having another hand transplant, but it may make it more difficult to match you with a donor.
Chronic rejection. Chronic rejection happens over a longer period of time. Your hand may become painful and lose function. You may notice a loss of hair on your hand or changes in your fingernails.
You'll learn to watch for early signs of rejection. Report any changes in the appearance or sensation in your hand to your transplant team. If your transplant team suspects your body is rejecting your donor hand, you may need to begin taking more anti-rejection medications. Your transplant team will likely order tests to be done on your hand, including a biopsy of the tissue in your donor hand.
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Immunosuppressants are medications you take to prevent your body from rejecting your donor hand or hands. Immunosuppressants are powerful medications that you will need to take for the rest of your life. Major side effects of immunosuppressants include:
Increased risk of serious infections, including cytomegalovirus (CMV)
Increased cancer risk
Increased risk of developing diabetes
Increased cholesterol, increasing the risk of heart disease
Less-serious immunosuppressant side effects include:
How you prepare
Evaluating whether to have a hand transplant
Before you can receive a hand transplant, carefully consider the risks of the procedure and whether you can commit to intense follow-up care that will last the rest of your life. Also consider what benefits you hope to gain from a hand transplant. Post-transplant care includes:
Regular appointments with transplant doctors and surgeons
Regular physical therapy
Taking immunosuppressant medications daily and managing the medications' side effects
Follow-up care with your primary care doctor for routine health screenings
You'll be evaluated by a transplant team. People with amputation at the midupper arm or below may be considered for transplant. To be considered for a hand transplant, a candidate must:
Pass a comprehensive physical exam that includes X-rays, blood tests and other measures of physical health
Pass a mental and emotional health evaluation that examines coping skills, family and social support, and ability to manage post-transplant care
Have no history of chronic nerve conditions, such as peripheral neuropathy
Have no serious medical problems, such as diabetes, kidney disease, heart disease or untreatable cancers
Have had no recent serious infections
Be a nonsmoker
Not abuse alcohol or illegal drugs
Complete a financial evaluation of post-transplant care expenses with a member of the transplant team
Although the one-year survival rate of transplanted hands has been excellent at institutions that are fully committed to the procedure, the number of hand transplants performed after 2008 has been small due to drug-related side effects, uncertain long-term outcome, and the high costs of surgery, rehabilitation and immunosuppression.
A team of surgeons will perform your surgery and provide your family with periodic updates on how your surgery is progressing.
Once the donor hand is ready to be attached to your arm, your surgeons will first attach your bones to the bones of the donor hand using small metal plates. Your surgeons will then use special sutures (stitches) to attach the blood vessels, nerves and tendons. Surgeons use a special operating room microscope to place the sutures. Once all the parts of the donor hand and recipient's arm have been attached, the skin is closed.
Hand transplant surgery is a complicated operation that can take 18 to 24 hours to perform.
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The first short-term success in human hand transplant occurred with New Zealander Clint Hallam who had lost his hand in an accident while in prison. The operation was performed on September 23, 1998 in Lyon, France by a team assembled from different countries around the world led by French Professor Jean-Michel Dubernard, including Prof Nadey Hakim, who represented the UK. A microsurgeon on the team, Earl Owen from Australia, was privy to the detailed basic research, much of it unpublished, that had been carefully gathered by the team in Louisville. After the operation, Hallam wasn't comfortable with the idea of his transplanted hand and failed to follow the prescribed post-operative drug and physiotherapy regime. His inaccurate expectations became a vivid example of the necessity of a fully committed team of caregivers, including psychologists, that can correctly select and prepare the potential transplant recipients for the lengthy and difficult recovery and for the modest functional restoration of a transplanted hand to be expected. Hallam's transplanted hand was removed at his request by the transplant surgeon Nadey Hakim on February 2, 2001 following another episode of rejection.A hand transplant was performed in Ecuador in 1964, but the patient suffered from transplant rejection after only two weeks due to the primitive nature of the immune-suppressing medications at that time.
The first hand transplant to achieve prolonged success was directed by a team of Kleinert Kutz Hand Care surgeons including Warren C. Breidenbach, Tsu-Min Tsai, Luis Scheker, Steven McCabe, Amitava Gupta, Russell Shatford, William O'Neill, Martin Favetto and Michael Moskal in cooperation with the Christine M. Kleinert Institute, Jewish Hospital and the University of Louisville in Louisville, Kentucky. The procedure was performed on New Jersey native Matthew Scott on January 14, 1999. Scott had lost his hand in a fireworks accident at age 24. Later in 1999, the Philadelphia Phillies baseball team asked him to do the honors of throwing out the ceremonial first pitch. The Louisville group went on to perform the first five hand transplants in the United States and have performed 12 hand transplants in ten recipients as of 2016.
In contrast to the earlier attempts at hand transplantation, the Louisville group had performed extensive basic science research and feasibility studies for many years prior to their first clinical procedure (for example, Shirbacheh et al., 1998). There was also considerable transparency and institutional review board oversight involved in the screening and selection of prospective patients.
In March 2000, a team of surgeons at the University of Innsbruck in Austria began a series of three bilateral hand transplants over six years. The first was an Austrian police officer who had lost both hands attempting to defuse a bomb. He has completed an around-the-world solo motorcycle trip using his transplanted hands.
University of Louisville doctors also performed a successful hand transplant on Michigan native Jerry Fisher in February 2001, and Michigan resident David Savage in 2006.
On January 14, 2004, the team of Professor Jean-Michel Dubernard (Edouard-Herriot Hospital, France) declared a five-year-old double hand transplant a success. The lessons learned in this case, and in the 26 other hand transplants (6 double) which occurred between 2000 and 2005, gave encouragement to other transplant operations of such organs as the face, abdominal wall and larynx.
On May 4, 2009 Jeff Kepner, a 57-year-old Augusta, Georgia resident underwent the first double hand transplant in the United States at the University of Pittsburgh Medical Center by a team led by W.P. Andrew Lee, who also had been performing careful basic research on such transplants for many years. A CNN story on his follow up demonstrated the limited functional restoration to be expected, particularly following bilateral transplantation.
On February 18, 2010 the first female in the United States underwent hand transplantation at Wilford Hall Medical Center in San Antonio, Texas. The procedure was performed by surgeons from The Hand Center of San Antonio and US Air Force.
On June 22, 2010, a Polish soldier received two new hands from a female donor, after losing them three years earlier while saving a young recruit from a bomb.
On March 8, 2011, 26-year-old Emily Fennell underwent an 18-hour surgery to attach a right hand. This was performed in the Ronald Reagan UCLA Medical Center.
March 12, 2011 Linda Lu became the recipient of the first hand transplant in the Southeast, performed at Emory University Hospital, from a donor Leslie Sullivent.
In the fall of 2011, 28-year-old Lindsay Ess received a double hand transplant at the Hospital of the University of Pennsylvania in an 11 1/2 hour surgery.
On December 27, 2012, 51-year-old Mark Cahill received a right hand transplant at Leeds General Infirmary in the UK. The recipient's hand was removed during the same 8 hour operation, reportedly allowing very accurate restoration of nerve structures, believed to be an international first.
On February 27, 2013, 38-year-old Eskandar Moghaddami received hand transplant surgery by the 15th of Khordad Hospital plastic surgery team in Tehran, Iran.
On January 13, 2015, doctors at the Kochi-based Amrita Institute of Medical Sciences and Research Centre (AIMS) successfully conducted India's first hand transplant. A 30-year-old man, who had lost both his hands in a train accident, received the hands of a 24-year-old accident victim.
On July 28, 2015, doctors at the Children's Hospital of Philadelphia performed the first successful bilateral hand transplant on a child. At the age of 2, Zion Harvey lost his hands and feet to a life-threatening infection. Six years later, at age 8, he had both of his hands replaced in a double hand transplant.
On October 26, 2016, the Director of hand transplantation at UCLA, Dr. Kodi Azari, and his team, performed a hand transplant on 51-year old entertainment executive from Los Angeles, Jonathan Koch at Ronald Reagan UCLA Medical Center. Koch underwent a 17-hour procedure to replace his left hand, which he lost to a mysterious, life-threatening illness that struck him in January 2015. On June 23, 2015, Koch had the amputation surgery, also performed by Dr. Kodi Azari, which was designed to prep him to receive a transplanted limb. This included severing the left hand closer to the wrist than the elbow. Azari kept all the nerves and tendons long and extended, which would give him plenty to work with later. Then he sutured them together and attached them to the stump of bone to keep them from retracting. This is the first known hand transplant case in which the hand was amputated in preparation for a hand transplant, as opposed to previous hand transplant patients who have undergone typical amputation surgeries. Azari's theory about prepping the hand for a transplant during the initial amputation surgery would later be supported by Koch when he was able to move his thumb only two hours after he woke up from the 17-hour transplant surgery and move his entire hand only two days after surgery.
The long-term functionality varies patient to patient and is affected by several factors including level of amputation and transplant and participation in occupational therapy post hand transplant surgery. Hand transplant recipient Jonathan Koch was able to pick up a napkin and a tennis ball with his newly transplanted hand 7 days after his 17-hour surgery and by day 9, he was able to pick up a bottle of water and take a drink. 3 months after surgery, Koch was able to use his transplanted hand to tie his shoe.
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