UCLA surgeons perform first hand transplant in California
A young mother who lost her right hand in a traffic accident five years ago has become the first person to receive a hand transplant in California and the 13th in the U.S., UCLA officials said Monday.
The Northern California woman, 26, whose name was not released, was doing well after the 14-hour procedure at the Ronald Reagan UCLA Medical Center’s new hand transplantation center. The operation concluded about 2:30 p.m. Saturday.
The recipient had been identified as a good candidate for the surgery last year after she contacted UCLA, but doctors had to wait to find an appropriate donor hand that matched the recipient’s tissue type and was of similar size, color and hair pattern. A Southern California family made the donation through Lifesharing, a nonprofit organ and tissue recovery organization in San Diego and Imperial counties. No other information was released about the donor.
The donor hand and the woman’s hand matched beyond expectation, said the physician who led the operation, Dr. Kodi Azari, surgical director of UCLA’s hand transplant program.
“It was really uncanny how perfect the match was. It’s going to look very natural,” he said. “The recipient was, in many ways, the ideal candidate, in that she found us, she had amazing knowledge about hand transplantation, she had done her homework.”
The recipient had used a prosthetic hand but was highly motivated to undergo a transplant, Azari said. She was selected as the team’s first case from about 50 people screened at UCLA.
“She wanted to be whole again,” Azari said. “She couldn’t tie her shoelaces. She couldn’t put her daughter’s hair in a braid. It was limiting her job function. There are people who say, ‘This is the only life I have, and the prosthetic arm is not enough for me.’ ”
UCLA announced the launch of a hand transplant unit last year, the fourth such center in the U.S. More than 40 hand transplants have been performed worldwide, including a few double transplants, since the first was done in 1998 in France. The inaugural U.S. hand transplant took place in 1999 at Jewish Hospital in Louisville, Ky.
The earlier surgeries were surrounded by controversy, said Dr. Warren C. Breidenbach, who conducted the first U.S. transplant.
“Right out of the gate, it proved to be successful, but it took time to see that,” Breidenbach said. “When the first French patient was done in 1998, there was a lot of fury. We followed in 1999, and there was a lot of concern about it. We were told it was unethical and shouldn’t be done. There is no longer debate that this procedure has a high potential for long-term survival of the hand.”
The latest statistics show a five-year success rate of about 92% to 95%, he said. Some patients have lived with a donor hand for more than 10 years. Although the transplant can fail, requiring removal of the hand, most recipients have done well and can feel sensation as well as perform daily tasks such as writing, picking up a glass or buttoning a shirt.
The procedure carries risks, however, even when it succeeds: Recipients must take immunosuppressant medications, typically forever, to reduce the chances that the body will reject the donor hand. These drugs can cause serious side effects such as lower resistance to infection and uncontrolled bleeding.
The world’s first hand transplant recipient had the hand removed a few years later because of rejection episodes and difficulty complying with anti-rejection drug therapy.
UCLA’s first patient believed that the benefits of the surgery outweighed the risks, her mother said in an interview Monday. She asked not to be identified.
“She looked for something that would give her full function,” the mother said. “Some things you just can’t do with one hand that you can do with two hands. There was a ceiling she just couldn’t crash through. She is quite young. She’s extraordinarily healthy. She really felt that the benefits and achieving fuller function in her life outweighed the risks.”
The patient, who will remain in the Los Angeles area for three months of post-surgical care and rehabilitation, is already moving her fingers and got her first good look at her new hand Sunday, her mother said. “She said, ‘That is so cool.’ ”
Hand transplantation grew from the convergence of two medical specialties: organ transplantation and the surgical reattachment of a severed hand.
The process for hand transplantation is similar to that of reattachment: Doctors must connect the severed bones and stitch together tendons, nerves, arteries and veins.
“The technique to put on a hand was known,” Breidenbach said. “We had been putting on hands that had been amputated; we were trying to put hands on that had been through a meat grinder.”
A donor hand is in many ways easier to deal with because it’s often in pristine condition, he said.
But in other ways, it is more difficult, because it adds a broad list of new challenges involving tissue matching and potential rejection.
It remains to be seen how functional the Northern California woman’s hand will be. The results are typically satisfactory in cases where the forearm has not been badly damaged and when the patient receives excellent surgical care and proper physical therapy after the transplant, Breidenbach said.
“You should be able to have a hand which will have approximately 60% to 70% of motion, 20% to 30% of strength, and the patient could have functionality that is about 60% of normal,” he said. In a handshake, the transplanted hand would look normal but would feel weaker, Breidenbach said.
“The reasonable expectation is she will get sensation back and she will use her hand,” Azari said. “So far, it looks spot on.”
The opening of UCLA’s hand transplant unit is a sign of the increasing acceptance of the procedure, Breidenbach said. Other transplant centers nationwide are also considering performing hand transplants.
“We’re into the phase of wider acceptance,” he said. “Now we’re talking about how good we can get the results.”
Surgeons are even debating whether a hand transplant should routinely be offered to amputees. However, it is unclear how many people will want the procedure because of the dangers of taking immunosuppressant medications for many years and because they may feel psychologically uncomfortable that the hand is not their own.
“I consider it experimental,” Azari said. “I don’t believe this should be done willy-nilly and by everyone.... What will be the challenge in the future, and will push this field forward, is research on anti-rejection medications to make them safer.”
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