Frequently Asked Questions About Reconstructive Transplantation
What is reconstructive transplantation?
Reconstructive transplantation is the umbrella term for transplants composed of multiple tissues, like the face or hand.
How are reconstructive face and hand transplants performed?
| Face transplants: |
Face transplantation is the transfer of facial tissue from one person to another for restoration of facial form and function.
It involves replacing missing tissue with similar structures from an organ donor. |
| Hand transplants: |
Hand transplantation is complex because the human hand consists of 27 bones, 28 muscles, 3 major nerves, 2 major arteries, and multiple tendons, veins, and soft tissue.
Surgery can last from eight to 10 hours or more and involves:
- bone fixation
- reattachment of arteries and veins
- repair of tendons and nerves
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How many face and hand transplants have been performed in the United States and worldwide?
| Face transplants: |
Two people have received face transplants at institutions in the United States. |
| Hand transplants: |
More than 65 people have received hand transplants at institutions around the world.
Check out UPMC's hand transplant patient stories. |
Who is on the UPMC Reconstructive Transplant team?
Who can participate in the UPMC face and hand transplant studies?
What is the research protocol for the reconstructive transplant program at UPMC?
UPMC uses the Pittsburgh Protocol, a research protocol that takes a new approach to regulating the body’s immune system to accept a transplanted organ.
Normally, the immune system treats a transplanted organ as foreign, like germs, and tries to destroy it.
Transplant medications regulate this process to control the immune system and allow acceptance of the new organ. These medications are vitally important and must be taken to prevent rejection.
With the Pittsburgh Protocol, the regimen has been designed to develop long-term transplant acceptance on minimal drug therapy.
The Pittsburgh Protocol differs from the immunosuppression protocol currently employed around the world.
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Induction therapy with antibodies, together with multi-drug maintenance therapy, represents the standard protocol currently used around the world in human hand transplantation.
Such drug regimens, while effective, have caused complications like infection and drug toxicity, among others, jeopardizing the benefits gained from otherwise successful hand transplantation. |
Surgeons and researchers at UPMC propose using the Pittsburgh Protocol for immunosuppression after hand transplant.
It's composed of two elements:
- treating the patient with antibodies on the day of transplant
- followed by a donor bone marrow infusion several days later
When used in solid organ transplants at UPMC, this protocol allows patients to be treated with low doses of a single maintenance drug. |
What is rejection after reconstructive transplantation?
Rejection refers to the body’s immune response towards the newly transplanted facial tissues or hand.
Believing the tissues to be “foreign,” the body’s natural response is to attack. This can occur within days to months after transplant.
How is rejection detected or diagnosed in face and hand transplants?
For both face and hand transplants, rejection:
- almost always appears first in the skin, anywhere on the transplant
- may appear as a rash that is spotty, patchy, or blotchy
- is usually painless
Unlike internal organ transplants, where rejection is difficult to spot early, it's easy to detect and monitor in the face and hands, allowing for early medical intervention.
Transplant recipients should carefully watch for signs of rejection, and immediately report them to their physicians for timely biopsy and treatment.
How many hands have been lost to rejection?
To date, only one patient in the world is known to have lost a transplanted hand to suspected rejection, despite appropriate medication.
How is a donor face or donor hand selected for transplantation?
| Face transplants: |
Special care is taken to match not only the biological factors — including blood and tissue type — but also gender, race, and skin tone, to ensure an aesthetically pleasing result. |
| Hand transplants: |
In contrast to the case of identifying a solid-organ donor, selecting a donor for a hand transplant must involve additional and careful emphasis on matching:
- skin color and tone
- gender
- ethnicity and race
- hand size
|
Does the recipient who receives donated facial tissues physically resemble the donor after transplantation?
No.
Because face transplant recipients retain most of their facial structure and muscles, the transplanted tissues will no longer resemble the donor. Instead, they will take on the facial features of the recipient.
And, since the brain controls facial movements, the personality expressed by the face remains that of the recipient.
What is therapy like after hand transplant surgery?
Patients are encouraged to start moving the hand early — within 24 to 48 hours after surgery — to reduce edema and stiffness.
Therapy after hand transplant is long and intensive. Patients are educated, before surgery, on the critical importance of rehabilitation in improving functional outcome after the procedure.
What is the current status and future of reconstructive transplantation?
In the last decade, around 80 different reconstructive transplantation surgeries have been performed with success.
Since its inception, reconstructive transplantation has faced and endured much speculation, debate, controversy, and scrutiny. Early world outcomes have confirmed that satisfactory to excellent function can be achieved with these types of procedures.
The goal now is successful avoidance of the risks of high-dose multiple drug therapy to prevent rejection.
Strategies like the Pittsburgh Protocol, that aim to minimize maintenance immunosuppression, have been studied in organ and hand transplantation at UPMC.
Realization of such protocols in clinical reconstructive transplantation will herald a new era of reconstructive transplant surgery to treat complex and major tissue defects.
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