UPMC/University of Pittsburgh Schools of the Health Sciences
Hand Transplant Fact Sheet
History and Evolution of Hand Transplantation
The first hand transplant was performed in Ecuador in 1964 and utilized immunosuppressive drugs that were primitive by today’s standards. The hand was lost to rejection two weeks after transplant. It took three decades of basic and clinical research before a second attempt at hand transplantation was made. In December 1998, a team in Lyon, France, performed the world’s second hand transplant under a modern triple-drug regimen as used in organ transplants. A month later, the first American hand transplantation was performed in Louisville, Kentucky. At 10 years, it is the longest surviving hand transplant in the world. The world’s first bilateral, or double-hand, transplant was performed in Lyon, France, in 2000. Most recently, the world’s first double arm transplant was performed by a team in Munich, Germany, in 2008.
Following the early attempts in the ‘90s, more than 32 patients have received hand transplants at institutions around the world. In the world experience, hand transplantation has been successful with a cocktail of multiple immunosuppressive drugs. Nevertheless, patients can suffer from a wide array of side effects. Researchers at UPMC believe that reducing the number, dosage and frequency of drugs will significantly minimize the adverse effects of immunosuppression, thus reducing risk and optimizing the life-enhancing outcomes of hand transplantation. In doing so, composite tissue allotransplantation (CTA) researchers can increase the clinical applicability of hand transplantation and achieve the goal of making it a routine reconstructive surgical procedure for patients suffering from major limb loss.
Immunosuppression in Hand Transplantation
The treatment protocol at UPMC has been successful in kidney and liver transplants in reducing drug treatment after surgery. The goal of the current study is to reduce immunosuppression from the conventional triple-drug therapy to reduce long-term risks.
The risks of high dosages and combinations of anti-rejection drugs are well documented. Because these drugs have to be taken for as long as the person retains the transplanted tissues, doctors are especially concerned about their toxic side effects, which can include hypertension, diabetes, increased risk of infection, liver and kidney dysfunction and increased risk of developing certain types of cancers. The risks of immunosuppression have long been a concern of critics of CTA programs. Unlike a liver or heart transplant, where the life-saving benefit outweighs the risk of lifetime use of anti-rejection drugs, a similar argument for a non-life saving transplant like a hand has been problematic.
Building on decades of immunology research at the Thomas E. Starzl Transplantation Institute at UPMC, the Division of Plastic and Reconstructive Surgery at UPMC has developed a treatment protocol based on a two-phase regimen that it believes will enable patients to be treated with a reduced dosage of anti-rejection drugs for the long-term.
Patients in the UPMC program receive a bone marrow infusion from the hand donor shortly after the hand transplant. Researchers deliver the bone marrow at this point to help the recipient overcome the initial overwhelming immune response against the hand transplant. The bone marrow cells target specific cells that could reject the hand and help “re-educate” the immune system into thinking that the transplanted hand is not a foreign object, and, thus, not attacking it. Patients will be treated with tacrolimus, a drug that was first used in liver transplants by Dr. Starzl over two decades ago. Tacrolimus has successfully prevented rejection at low doses and at reduced frequency in kidney and liver transplants performed at UPMC.
UPMC Hand Transplant Program
Currently, the division is seeking participants with loss of the hand or forearm to enroll in their hand transplant study. Patients must be between the ages of 18 and 60 and have amputation at the wrist or forearm level.
Patients should expect to undergo extensive therapy following the transplant to regain function and movement in the transplanted hand. They will also have to remain in the Pittsburgh area for up to three months following surgery to be closely monitored and treated for signs of rejection and to participate in intensive rehabilitation therapy.