Team performs bilateral hand transplant at the Hospital of the University of Pennsylvania

A double hand transplant was successfully performed for the first time at the Hospital of the University of Pennsylvania in Philadelphia by Penn’s Hand Transplant Program, under the leadership of the Penn Transplant Institute and in collaboration with the Gift of Life Program.

A 30-member team including 12 surgeons, three anesthesiologists and 15 nurses, performed the 11.5-hour surgery. The team included experts in orthopedic surgery, solid organ transplantation, plastic surgery, reconstructive microsurgery and anesthesia.

According to L. Scott Levin, MD, FACS, director of the Penn Hand Transplant Program and chairman of the department of orthopedic surgery, the female recipient, who is in her 20s, is doing well. Levin said the recipient, who wished to remain anonymous, now has the ability to brush her face, wave and gesture using her hands a month after the transplant.

“Our patient is doing extremely well,” Levin said at a press conference at the Hospital of the University of Pennsylvania. “She already has more functional ability than she did a month ago.”

Planning, donor requirements

Levin discussed the evolution of the hand transplant surgery, calling it “2 years and 4 months in the making.” At the press conference, Levin chronicled the details of the surgery from initial conversations involving the ethics of performing serious life-enhancing surgery to post-surgical rehabilitation for the recipient.


	L. Scott Levin

“Certainly there are tremendous ethical considerations based on donors, donor families, patients, the fact that this is life-enhancing surgery, not necessarily life-saving surgery like a heart transplant,” Levin said. “Nevertheless, the patients that will benefit from this type of surgery are treated similarly to solid organ transplants.”

The recipient underwent extensive medical screenings and evaluations before surgery. It was necessary that the donor had the right skin type, age, gender, size of hands and forearms, according to Levin, making the transplant different than solid organ transplants.

During the surgery, located just below the elbow, the hands and forearms from a donor were attached to the recipient, which involved connecting bone, blood vessels, nerves, muscles, tendons and skin.

“We started to design this operation for a double transplant about a year-and-a-half ago when the entire surgical team got to meet our patient for the first time,” Benjamin Chang, MD, co-director, Penn Hand Transplant Program and director and associate chief, division of plastic surgery, said. “We worked out a step-by-step detailed procedure for performing the bilateral transplant.”

Postoperative therapy

The recipient is undergoing extensive physical rehabilitation.

“In terms of the duration and intensity of therapy, it is several hours a day,” Levin said. “Our patient is extremely motivated, our therapists are incredibly dedicated and each day she is learning. Based on fatigue, it may be two steps forward and one step back, but her therapy will go on because she is using her extremities in a much different way.”

Levin anticipates that the patient will spend hours a day undergoing rehabilitation for up to a year. The therapy for muscle building, motion of joints, bones and wrists will likely last more than a year, according to Levin. The recipient is also prescribed daily immunosuppressive medications to prevent rejection of the new limbs.

“We prepared, we studied, we listened to each other and we came together as an unbelievable team and made something happen that I think is very unique,” Levin said. “We will go forward with other candidates. We have learned a lot from our patient, and our patient has learned a lot from us. We have done this safely and we have done this critically, looking at all the factors that could result in failure. Failure is never an option, but failure can occur. Complications can occur. But, I am pleased to say that at this point, there is no evidence of rejection from this patient.”

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