McGowan Institute for Regenerative Medicine
faculty member W. P. Andrew Lee, MD, chief of the division of plastic surgery and reconstructive surgery at UPMC and professor of surgery and orthopedic surgery at the University of Pittsburgh School of Medicine, and members of the UPMC hand transplant surgical team recently reported the successful hand transplants of two patients. Both patients are being treated with the “Pittsburgh Protocol,” an immune modulation therapy that aims to reduce the risks associated with toxic anti-rejection drugs.
A 27-year-old New Jersey resident who lost her hand 5 years ago became the fourth patient to receive a hand transplant at UPMC. On September 11, Jessica Arrigo received a unilateral, or single hand, transplant of her right hand. A 33-year-old woman, also from New Jersey, on September 18 became the first female in the United States to receive a bilateral hand transplant. Sheila Advento, whose hands were amputated after an infection 7 years ago, became the fifth patient at UPMC to receive a hand transplant.
“The goal of our program has always been to make hand transplants safer as a viable alternative to prosthetics. With each successful surgery, we are closer to that goal,” said Dr. Lee. The first hand transplant at UPMC was performed in March 2009.
A team of surgeons, critical care specialists, transplant nurses, and therapists has cared for Ms. Arrigo and Advento since their 12-hour surgeries. The patients will perform daily occupational therapy at the UPMC Rehabilitation Institute as their physicians monitor them closely for signs of rejection.
Although other surgeons from around the world have performed hand transplants successfully, they have used a conventional protocol of multiple immunosuppressive medications to prevent rejection of the grafts, increasing the risk of diabetes, infections, hypertension, and other disorders.
In contrast, surgeons at UPMC have implemented a two-phase protocol that involves initial antibody treatment followed by donor bone marrow cell therapy. The goal is not merely to suppress the immune system, but to change the way it functions. Under the protocol, both Ms. Arrigo and Advento received antibodies to help overcome the initial overwhelming immune response. That was followed by a bone marrow infusion from the hand donors within 15 days after the surgery. Hand transplant patients are treated with tacrolimus, a drug that was first used in liver transplants by UPMC’s Thomas E. Starzl, M.D., Ph.D., more than 2 decades ago to prevent graft rejection.
“All of our previous hand transplant recipients have been maintained on a low-dose of a single anti-rejection drug and have regained significant function and sensation in their transplanted hands,” said members of the UPMC hand transplant surgical team.
UPMC, the U.S. Army Institute of Surgical Research, and the Armed Forces Institute of Regenerative Medicine are funding the hand transplant study. Surgeons performed the first unilateral hand transplant at UPMC on March 14, 2009, the first bilateral hand transplant in the U.S. on May 4, 2009, and the second bilateral hand transplant on February 5, 2010.
Illustration: UPMC surgeons perform nation’s first female bilateral hand transplant. –UPMC Media Relations.
UPMC Media Relations News Release (09/14/10)
UPMC Media Relations News Release (09/24/10)
Pittsburgh Post-Gazette (09/25/10)
UPMC Media Relations Hand Transplant
Bio: Dr. W. P. Andrew Lee