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UK surgical team reports encouraging early results of first hand transplantation

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f79 (Published 04 January 2013) Cite this as: BMJ 2013;346:f79
  1. Susan Mayor
  1. 1London

A surgical team has reported encouraging results of the United Kingdom’s first hand transplant operation, which used a new technique to amputate the recipient’s non-functioning hand during the procedure, enabling the surgeons to accurately rebuild nerve structures to the transplanted hand.

The team at Leeds General Infirmary carried out the complex eight hour operation on 27 December 2012, after a donor limb became available. Its tissue matched one of the two patients listed to receive a hand transplant, 51 year old Mark Cahill, who was unable to use his right hand because of severe gout.

“This operation is the culmination of a great deal of planning and preparation over the last two years by a team including plastic surgery, transplant medicine and surgery, immunology, and rehabilitation medicine,” said Simon Kay, the consultant plastic and reconstructive surgeon who led the operation.

“The team was on standby from the end of November awaiting a suitable donor limb, and the call came just after Christmas,” he explained. “It is still early days, but indications are good and the patient is making good progress.”

Hand transplantation was pioneered in Lyon, France, in 1998. Kay works closely with the transplant team in Lyon, where several successful hand transplantations have been carried out. But this was the first time that a patient’s hand had been amputated during the procedure to attach the transplanted hand.

Two surgical teams worked alongside each other, one removing the donor’s hand while a second amputated the patient’s hand. They mapped the nerves, blood vessels, and tendons very precisely before transplantation, marking them up on each hand.

This enabled them to connect the three nerves, eight blood vessels, and tendons and bones in the patient’s wrist very accurately to those in the donor hand. After attaching the bones and some tendons, the team connected the blood vessels to restore circulation to the transplanted hand. The remaining tendons were then connected and the nerves repaired.

A hospital spokesman said that the patient could not yet feel the transplanted hand but that he could move the fingers slightly. The spokesman said, “The team considers that the transplant is doing better than some other similar transplants at this stage,” adding that it was too early to comment on the success of procedure, given the risks of transplantation.

The team envisaged that feeling would develop gradually in the patient’s new hand. He is receiving physiotherapy to support rehabilitation and has also had psychological support to help him accept the new hand as his, despite the difference in appearance.

The surgical team announced in late 2011 that it was starting to look for potential candidates for hand or arm transplants after gaining considerable previous experience in surgery to reattach patients’ hands after accidental injury. It developed protocols in collaboration with NHS Blood and Transplant, the agency that oversees tissue and organ transplantation in the UK, and set up a website about the UK hand transplant programme (www.handtransplantuk.com) to provide information to patients and health professionals.

Commenting on the procedure, Norman Williams, president of the Royal College of Surgeons, said, “This is yet another example of life changing surgical advancements that are now possible. New surgical techniques together with a greater understanding of organ rejection are making an ever wider range of transplants feasible.” But he cautioned on the need to select patients who fully understood the risks and benefits of transplantation.

Notes

Cite this as: BMJ 2013;346:f79