The world’s first double hand transplant in a child has been successful under carefully considered circumstances. The study, which is published in The Lancet Child & Adolescent Health journal, presents the first medical report of the surgery and 18 months of follow-up.
The recipient of the transplant was an 8-year-old boy based in the USA, who is now able to write, and feed and dress himself independently following months of occupational therapy and psychological support.
However, during this time he also faced setbacks, including treatment of numerous rejections of the hands and extensive rehabilitation to help him learn to use his hands.
“Our study shows that hand transplant surgery is possible when carefully managed and supported by a team of surgeons, transplant specialists, occupational therapists, rehabilitation teams, social workers and psychologists,” says Dr Sandra Amaral, Children’s Hospital of Philadelphia, USA. “18 months after the surgery, the child is more independent and able to complete day-to-day activities. He continues to improve as he undergoes daily therapy to increase his hand function, and psychosocial support to help deal with the ongoing demands of his surgery.”
Previously, this type of transplant had been used for single limbs between identical twins and in adults. In another case involving a teenager who received a donor limb, there were severe complications and the patient died soon after surgery.
The first double hand transplant surgery in a child took place at Children’s Hospital of Philadelphia in collaboration with Penn Medicine.
The boy was chosen for the surgery as he was already receiving immunosuppression for a kidney transplant, caused by a sepsis infection that also resulted in the earlier amputation of his hands and feet at the age of two.
Before the double hand transplant, he had limited ability to dress, feed and wash himself through adapted processes, using his residual limbs or specialist equipment. His mother’s hopes for the surgery were for him to be able to dress, brush his teeth, and cut food independently, and the boy wanted to be able to climb monkey bars and grip a baseball bat.
The surgery took place in July 2015, when suitable donor organs became available from a deceased patient, and involved four medical teams working simultaneously on the donor hands and the child.