UPMC hand transplant will be a first

Surgeons at the University of Pittsburgh Medical Center are expected to perform a rare hand transplant as soon as a donor becomes available, officials said.

Four patients are on a waiting list, following extensive medical and psychological testing, said Dr. W.P. Andrew Lee, chief of plastic surgery and professor of surgery at UPMC.

It would mark the first time surgeons at UPMC perform the one-of-a-kind surgery, which has been successfully performed around the world and at Jewish Hospital in Louisville.

"We're just waiting for the call," Lee said.

Donors could be procured from Western Pennsylvania and adjacent states. For the transplant to work, doctors much match not only tissue type but skin color, size and gender. People who would benefit from a hand transplant include soldiers injured in combat, people involved in accidents or those who lost a limb because of an illness, Lee said.

"A lot of time they don't have personal independence," he said. "For a lot of those patients, a hand transplant can not only allow them to perform activities of daily living but in some cases make them feel whole again and restore their personal autonomy."

That's the case for Jessica Arrigo of Millville, N.J. She is one of the four patients on the waiting list and wants to have the surgery before setting a date for her wedding.

"It's just crazy. I just can't believe that I was chosen to be one of the people to have this done," said Arrigo, 25. "It's hard for me to believe."

Arrigo lost both legs and most of her two hands four years ago after getting sick with a stomach virus. The illness progressed to the point where she went into a coma and developed septic shock as a result of the infection.

Up to that point, Arrigo, who had just turned 21, led a normal life, working at a gym, playing golf and running. Surprisingly, however, her illnesses and the loss of her legs and hands, did not faze her.

"It's been ridiculously smooth," Arrigo said. "I understand it should have affected me, but it really hasn't."

Arrigo said losing her limbs hasn't changed her life much. She recently went skydiving, for example. But she dreams of being able to wear her engagement ring and wedding band.

"It'll just make everything easier," she said.

The technique used by UPMC surgeons would differ from procedures performed elsewhere because it would not involve a conventional regimen of anti-rejection medicine. Instead, it would involve the so-called Pittsburgh protocol, which has been used in some organ transplants at UPMC. That utilizes antibody therapy just before the transplant, bone marrow cell infusion from the donor, and treatment with one anti-rejection drug instead of the typical three.

The key difference is the bone marrow cell infusion, a technique doctors have used in kidney and heart transplant patients. Doing this increases the chances of weaning patients off immunosuppression drugs, which have often harmful side effects including development of high blood pressure and diabetes.

"It is very important to balance the benefits of hand transplantation against the possible complications or risks of the medications," Lee said.

Trying to control the use of immunossupression is a critical aspect of hand transplantation because the surgery is not viewed as a life-extending procedure but as life-enhancing, said Dr. Warren C. Breidenbach of the Kleinert Kutz Hand Care Center in Louisville, who performed five successful hand transplants at Jewish Hospital.

Breidenbach said studies show patients missing a limb are willing to take the risk brought on by immunosuppression, because hands and feet are precious body parts.

"In general, it makes common sense that people will trade years of their life for quality of life," Breidenbach said.

About 40 hand transplants have been performed worldwide, Breidenbach said. But a lack of donors has hampered such transplants. That could change as more success stories become public, Breidenbach said.

Some families might worry that agreeing to a hand donation would alter the appearance of a deceased loved one, but Lee said donors would be fitted with a prosthesis for the funeral.

Recipients get detailed information about the surgery, a procedure that lasts eight to 12 hours. Surgeons must fuse bones, blood vessels, muscle, tendons, nerves and skin. Patients undergo three months of intensive rehabilitation afterward.

"We want to make sure they understand the risks and benefits," Lee said.