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Fall 2010

UCLA Launches Pioneering Hand Transplant Program

In a major step toward establishing a new surgical frontier, UCLA Health has created the first hand transplantation center on the West Coast — and only the fourth program of its kind in the United States.

The first successful hand transplant was performed in France in 1998, with the United States following the next year. Worldwide, approximately 50 patients have had the procedure, nine of them (including two double-hand transplant recipients) in the United States.

Life-saving solid-organ transplants have become increasingly common at major medical centers such as UCLA. But hand transplantation represents a new direction for the field — a so-called composite tissue transplant (bones, tendons, arteries, nerves) — to enhance quality of life. And to accomplish it requires a delicate balance.

“The hand is an amazing tool. It has the power to swing a sledgehammer, yet at the same time it has the precision to play a concert piano,” says Kodi Azari, M.D., associate professor in the UCLA Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery and surgical director of the UCLA Hand Transplantation Program. “The precision is based on the balance between tendons on the back of the hand and the palm of the hand. These have to be absolutely perfectly balanced, and one of the critical elements in transplant surgery is reestablishing that balance.”

Dr. Azari, one of the lead surgeons on five of the successful hand transplants in the United States — including the first double-hand transplant and the first arm transplant — explains that when patients are born without hands or lose a hand as a child, they are more easily able to adapt to the circumstances. But it is far more difficult for adults.

“Many patients who have lost one or both hands find that prosthetic devices are not enough to help them get back the life they had enjoyed previously because they lack the sense of touch of a human hand,” Dr. Azari says. “In these cases, hand transplantation can offer a unique opportunity to regain dynamic function and the feel of a real human hand.”

VS-Fall10-Hand Transplant ProgramBoth the preparation for the surgery and the procedure itself are complex, and require a large team. The UCLA Hand Transplantation Program involves a partnership between UCLA’s transplantation services and hand surgery, plastic and reconstructive surgery, orthopaedic surgery, psychiatry, pathology, anesthesia, internal medicine, radiology, neurology, ethics and rehabilitation services.

The procedure requires as many as 10 specialized surgeons collaborating for eight to 12 hours to fix the bones and repair the arteries, veins, nerves and tendons, as well as to repair the skin. This type of multiple-tissue transplant presents immunological challenges, Dr. Azari notes. As with solid-organ transplants, patients who undergo a limb transplant must take immunosuppressive medications to prevent rejection of the graft.

The other challenge is a functional one. “You don’t see your liver or your kidney, but you see and use your hand every day,” Dr. Azari says. “With other transplants, we don’t have to worry about return of nerve function, but we do with this one. Patients need to go through an intensive rehabilitation regimen to restore function to the transplanted hand.”

In addition to helping civilian patients, the program will serve military personnel who have been injured in Iraq and Afghanistan — acting as a complement to UCLA’s Operation Mend program, which offers facial and reconstructive surgery to wounded soldiers.

“UCLA has been a leader in transplantation for the past quarter-century, and this is a natural extension of that leadership,” Dr. Azari says. “We are excited to bring this program to UCLA.”

For more information about the UCLA Hand Transplantation Program and to watch a video with Dr. Azari, go to: http://www.handtransplant.ucla.edu

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