First Successful Double Hand Transplant

[P_RN, ADN, RN]

Reported in todays Medscape News.

http://www.medscape.com/viewarticle/458314?

July 7, 2003-Editor's Note: A French-Italian team performed the first hand transplant in September 1998, but the hand had to be removed after 23 months because the patient was not compliant with immunosuppressive therapy. Now this team has successfully performed the first double hand transplant with an excellent functional result, according to a case report published in the July issue of the Annals of Surgery.

The recipient was a 33-year-old man with bilateral amputation after a blast injury. Before transplantation, a psychiatric team determined his ability to understand the potential risks, the absolute necessity for immunosuppressive therapy, and his motivation to cope with intensive rehabilitation.

After procurement of the upper extremities from a multiorgan cadaveric donor, the surgical team prepared graft and recipient stumps, then attached the hands using bone fixation, arterial and venous anastomoses, nerve sutures, joining of tendons and muscles, and skin closure. Immunosuppressive treatment included tacrolimus, prednisone, and mycophenolate mofetil, with antithymocyte globulins and then CD25 monoclonal antibody for induction.

There were no surgical complications. Two episodes of acute skin rejection with maculopapular lesions resolved completely in 10 days on increased steroids.

A comprehensive rehabilitation program consisted of physiotherapy starting 12 hours after surgery twice daily for the first year, with controlled-motion passive exercises for the first two weeks, followed by active exercises to improve forearm pronation, wrist and finger extension, and pinch strength. At two months, the addition of electrostimulation and occupational therapy improved development of extrinsic and intrinsic muscles and sensory function.

By six months, the patient had sensitivity to pain and thermal stimuli on the dorsal and palmar aspect of both hands, on all fingertips except the left thumb, and on the anterior side of both forearms. By nine months, intrinsic muscles began to function, with continued recovery by 12 months. Electromyography and somatosensory evoked potentials confirmed partial reinnervation.

By one year, the patient could perform the same daily activities that were possible with myoelectric prostheses used before transplantation, and he could also perform additional activities including holding a pen, a glass, or a pair of scissors; shaving; and other personal hygiene tasks.

By 15 months, sensorimotor recovery tests revealed good functional return, except for limited active range of motion of the wrists, and quality of life had improved. Mean pinch grip was 300 g bilaterally; grip strength was 150 g; and he could perform several dissociated movements involving the fingers and thumbs.

Functional magnetic resonance imaging (fMRI) at 2, 4, 6, and 12 months showed cortical reorganization, with a progressive shift of cortical hand representation from the lateral to the medial region in the motor cortex.

Ongoing psychological support and evaluation revealed that during the first three months, the patient was worried about the eventual outcome and troubled by seeing the transplanted hands. However, by three months, he considered "the" hands to be "his own" hands. He continued to be compliant with the immunosuppressive regimen and with rehabilitation program, and his self-report showed satisfaction.

Although the surgical team felt that these results were at least as good as those achieved with replanted upper extremities, they await longer follow-up to demonstrate the final functional restoration. In the 15 months since the morificecript was submitted, the patient has had continued improvements and no complications.

[sanakruz, ADN]

HOLY MOLY- what a great story! Is this man living abroad or in the US?

[gwenith, BSN, RN]

I am glad they were successful this time. The first guy seemed to have a "poor me" attitude and was NOT the best/most compliant candidate they could have chosen.

[P_RN, ADN, RN]

From the same article: It's an interview with one of the authors. The surname looks French but it didn't say where he lives.

Denis Chatelier, who is the first ever person in the world to receive a double hand transplant, is doing very well since his transplant in January 2001. He is leading a normal life, back to his usual job in a factory, which involves using his hands. His function is back to over 65% of normal, which is a very reasonable result.

http://www.dpa.org.sg/DPA/news/news_january_2001-6.htm

OK he's French and here's a pic with the arms.