First US Hand Transplant Patient Does Things Hands On!

He can do it! The recipient of the world’s second (and  the US’s first) hand transplant  can use the hand to throw a ball, tie his shoes and turn the pages of the newspaper- activities he could not perform with his prosthesis. He can also feel pain, temperature and pressure sensation in his new left hand. This was reported in the August 17, 2000 issue of The New England Journal of Medicine by members of the Louisville, Kentucky, hand transplant team. According to them, their results and those of the first human hand transplantation, performed in France, showed that early success in hand transplantation could be achieved with the use of currently available immunosuppressive drugs.

 The recipient was 37 years old when the hand of a 58 year old cadaveric donor was transplanted in January 1999. Basilixmab was used for induction immunosuppression followed by Tacrolimus, mycophenolate mofetil and prednisone for maintenance. There were no early post transplant complications. Three episodes of moderate acute cellular rejection manifestated as a skin rash occurred at 6, 20 & 27 weeks post transplant. Each resolved after treatment with intravenous steroids and topical tacrolimus and clobetasol.

A dissenting note on the ethics of hand transplantation was put forward by James Herndon, MD of Harvard Medical School, Boston, MA in the same issue of the NEJM. According to him the complexity of composite tissue (bones, ligaments, tendons, muscles, blood vessels, skin) transplantation involved in a hand transplant would require more than one immunosuppressive drug to prevent rejection.

He felt that the procedure should be limited to a select group of patients like those who were already taking immunosuppressive drugs for life threatening problems and who lost a hand or patients who had lost both hands, and were also blind, while waiting for advances in immunosuppressive therapy.