Hand Transplant
July 16, 2009 Press Release: Nation's First Bilateral Hand Transplant Recipient Speaks About Surgery and Progress
Based on groundbreaking research and experience in solid-organ transplants, the University of Pittsburgh Medical Center (UPMC) has begun a novel clinical study on human hand transplantation that seeks to reduce the use of immunosuppressive drugs and their damaging side effects for patients.
Surgeons at UPMC performed their first unilateral hand transplant on March 14, 2009, followed by the nation’s first bilateral hand transplant on May 4, 2009. Both recipients are undergoing occupational therapy and are expected to regain significant function and sensation in their transplanted limbs in the coming months.
Although surgeons from around the world have performed hand transplants successfully for almost 10 years, they have used multiple immunosuppressive medications to prevent rejection of the grafts, increasing the risk of diabetes, hypertension and other disorders.
In contrast, researchers and surgeons at UPMC propose to implement an immunomodulatory approach known as the “Pittsburgh Protocol,” which entails antibody therapy, donor bone marrow cell infusion and treatment with a reduced amount of immunosuppressive drugs to reduce toxicity for patients.
“We will be offering another, potentially safer alternative for those who have lost a hand,” said W.P. Andrew Lee, M.D., chief of the division of plastic surgery and professor of surgery at UPMC. “With our focus on reducing the multiple immunosuppressant drugs typical of this procedure, we believe that we can restore what many amputees have lost without the risk of devastating side effects.”
Pittsburgh Protocol
Surgeons at UPMC will adapt a two-phase protocol that involves initial antibody treatment followed by bone marrow cell therapy. The goal is not merely to suppress the immune system but to change the way it functions. Transplant patients will receive antibodies to help overcome the initial overwhelming immune response. That will be followed by a bone marrow infusion. 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. Patients will be treated with tacrolimus, a drug that was first used in liver transplants by Thomas Starzl, M.D., Ph.D., over two decades ago, to maintain the low-grade immunosuppression needed to prevent long-term graft rejection.
“Unlike a solid-organ transplant, which is needed to prolong life, a hand transplant improves only the quality of life,” said Dr. Lee. “We take very seriously the long-term health of our patients. We have devoted many years of research to developing an immunomodulatory protocol that will reduce the risks of the procedure. We believe our new protocol will achieve this goal, allowing more amputees to be considered for hand transplants in the future.”
Hand Transplant Study Protocol
UPMC researchers are seeking patients between the ages of 18 and 60 with amputation at the forearm or below who are interested in receiving a hand transplant. Selected patients will undergo intensive medical screenings and psychological evaluation. Eligible subjects will be invited to undergo a comprehensive informed consent process and placed on the transplant list to await a potential donor. Those who receive transplants will be expected to stay in the Pittsburgh area for three months after the surgery to undergo extensive therapy and careful monitoring and assessment by physicians.
For more information on enrollment in the hand transplant program, please click here to view the criteria or call 412-648-9207.