UPMC/University of Pittsburgh Schools of the Health Sciences

Hand Transplant Frequently Asked Questions​

What is CTA?
CTA stands for Composite Tissue Allotransplantation and is the umbrella term for tran​splantations composed of multiple tissues like the hand or face.

Who is eligible to participate in the UPMC Hand Transplant Study?
People between the ages of 18 and 60 with amputation at the forearm or below are eligible. Those who fit this criteria will be rigorously evaluated before being considered candidates for hand transplantation.

How many total hand transplants have been performed worldwide?
More than 32 patients have received hand transplants at institutions around the world. The longest surviving hand transplant is the first U.S. recipient at almost 10 years.

What is the immunosuppression protocol currently employed around the world in hand transplantation?
Induction therapy with antibodies together with multi-drug maintenance therapy represents the standard 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.

=What is the protocol proposed for the hand transplant program at UPMC and how is it different from current regimens?
Surgeons and researchers here are proposing the use of the Pittsburgh Protocol for immunosuppression after hand transplant. It is 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 hand transplantation?
Rejection refers to the body’s immune response towards the newly transplanted hand. Believing the tissues to be “foreign,” the body’s natural response is to attack and can occur within days to months after transplant. A scoring system for rejection was established by Dr. Stefan Schneeberger.

How is rejection detected or diagnosed in hand transplants?
Rejection can appear as a rash that could be spotty, patchy or blotchy. It could appear anywhere on the transplant and is usually painless. As rejection almost always appears first in the skin, patients are encouraged to carefully watch for the signs and report to the physician for timely biopsy and treatment. Unlike internal organ transplants, where rejection is difficult to spot early, it is easy to detect and monitor in the hand, allowing for early medical intervention.

How many hands have been lost to rejection?
No patient lost his/her hand if they took their immunosuppression drugs on time and as advised.

How is a hand transplant performed?
The human hand consists of 27 bones, 28 muscles, 3 major nerves, 2 major arteries, multiple tendons, veins and soft tissue. The surgery is complex and can last from eight to ten hours. It involves bone fixation, reattachment of arteries and veins and repair of tendons and nerves.

How is a donor hand selected for transplantation?
In contrast to the case of identifying an organ donor, selecting a donor for a hand transplant must involve additional and careful emphasis on matching skin color, skin tone, gender, ethnicity and race and the size of the hand.

What is therapy like after hand transplant surgery?
Patients are encouraged to start moving the hand early, within 24 to 48 hours, to reduce edema and stiffness. Therapy after hand transplant is long and intensive and 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 CTA?
In the last decade, around 80 different CTA surgeries have been performed with success. Since its inception, CTA 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 transplantation at UPMC. Realization of such protocols in clinical CTA will herald a new era of reconstructive transplant surgery to treat complex and major tissue defects.​​

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