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Physicians Update

 
Fall 2010

Hand Transplantation Program Opens New Surgical Frontier

12/01/2010

PU Fall 2010-Hand TransplantationIn a major step toward opening a new frontier in transplantation, UCLA Health has launched the UCLA Hand Transplantation Program, the first of its kind on the West Coast and one of only a handful of such centers in the United States.

The first modern-era hand transplantation was performed in 1998 in France, with the United States following suit the next year. Worldwide, more than 50 patients have had the procedure, 12 of them (including four double-hand transplants) in the United States. The UCLA Hand Transplantation Program is now accepting subjects for a clinical study to determine whether the surgical techniques established for hand transplantation are successful, the extent to which the transplanted hand returns to function, and the effectiveness and safety of the antirejection drugs needed to ensure the donor hand is not rejected by the recipient.

Plastic surgeon and hand surgeon Kodi Azari, M.D., surgical director of the new program — as well as one of the lead surgeons on six of the successful hand transplants in the United States, including the first double-hand transplant and the first arm transplant — discusses this new direction for transplantation.

Who is eligible for the trial, and who stands to gain if hand transplantation moves beyond the experimental phase?

For now, we are seeking individuals who have lost their hand or forearm through a traumatic accident or in the course of military combat. In addition to helping civilian patients, the program serves as a complement to UCLA’s Operation Mend program, which offers facial and reconstructive surgery to service personnel who have been injured in Iraq and Afghanistan. Ultimately, there is a fairly sizable population that could benefit from this procedure, particularly those who suffered the loss as an adult. People who are born without hands tend to adapt much more easily. We’ve all seen images of adults who have no hands yet are driving, eating, drawing and playing musical instruments. But for people who lose hands as adults, it’s much harder because the brain doesn’t have the same plasticity as a child’s and is not as able to adapt.

How does this compare to the prosthetic alternative in terms of a patient’s quality of life?

Many people do very well with prosthetics. But the prosthetic doesn’t provide the sense of feel and touch of a human hand. You have to take it off and put it back on all the time. And many patients who have lost one or both hands decide that prosthetic devices are not enough to help them get back to the life they had enjoyed previously. For these patients, transplantation can offer a unique opportunity to regain the dynamic function and feel of a real human hand.

What does the procedure involve?

Both the preparation and the surgery itself are complex and require a large team. The Hand Transplantation Program involves a partnership between UCLA’s transplantation services, hand surgery, plastic and reconstructive surgery, orthopaedic surgery, psychiatry, pathology, anesthesia, internal medicine, radiology, neurology, ethics, social work and rehabilitation services, all working together preoperatively. The procedure itself requires as many as 10 specialized surgeons working together for eight to 12 hours to fix the bones and repair the two major arteries, four veins, three major nerves and more than 20 tendons, as well as to repair the skin.

How are the challenges different from those of traditional transplants?

PU Fall 2010-Hand TransplantThere are immunological challenges related to the fact that this involves not a solid organ but composite tissue — bone, tendon, nerve, artery, ligament, muscle and skin. Thus, these patients will need to 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. With other transplants we don’t have to worry about return of nerve function, but we do with this one. As a result, patients need to go through an intensive rehabilitation regimen to restore function to the transplanted hand.

Transplantation has been done for decades now. Other than involving a different body part, what is new about this?

Neither transplantation nor hand reattachment is new; what is new is combining the two fields into one: reconstructive transplantation. This is a new direction — transplantation not to save lives, but to improve the quality of lives. That’s why we are excited to bring this program here. UCLA has been a leader in transplantation for four decades, and this is a natural extension of that leadership. 7 UCLA Physicians Update Kodi Azari, M.D.

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





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