Frequently Asked Questions
What is vascularized composite allotransplantation (VCA)?
Vascularized composite allotransplantation (VCA) is the surgical transplantation of body parts that contain multiple tissue types/organs (composite) as a unit including bone, muscle, tendons, nerves, blood vessels, and skin. Some examples include the arm/hand, face, abdominal wall, larynx, and lower extremity. VCA is a quickly growing multidisciplinary field pioneered by plastic and reconstructive surgeons and transplant physicians with the aim of restoring form and function to people with the most severe acquired defects.
What is hand transplantation?
Hand transplantation is the surgical attachment of a hand and sometimes arm from an organ donor to a person who has previously suffered an amputation. It is similar to other organ transplants such as a heart, liver, or kidney, in that the tissue comes from a deceased donor and therefore requires lifelong medications to prevent rejection. Hand transplantation also requires an extensive post-operative hand rehabilitation process to regain function of the transplanted limb.
Who is eligible for a hand transplant?
People who have lost one or both hands, who are in good general health, and are motivated to complete the post operative hand therapy regimen. They must also have complete dedication to taking the immunosuppression (anti-rejection) medications as prescribed. To see a more complete list click here.
What immunosuppression (anti-rejection) medications must be taken after a hand transplant?
The medication regimen to prevent rejection of a hand transplant is very similar to a kidney transplant. The SIU hand transplant immunosuppression protocol includes starting out with Thymoglobulin, followed by steroids, tacrolimus, and mycophenolate mofetil. The steroids will be decreased and stopped within five days of surgery. Patients will then be maintained on dual drug therapy with tacrolimus and mycophenolate mofetil. If these medications are not well tolerated, then transition to sirolimus and/or mycophenolic acid will take place. If the patient has a rejection episode (quite common in hand transplants) this will be treated with steroids and sometimes other medications like thymoglobulin. Prophylactic medications will be used to prevent infections such as bactrim, valganciclovir, and nystatin.
What does the post-operative physical therapy regimen consist of after hand transplantation?
Dedication to the hand rehabilitation process following a hand transplant is one of the most important components to a successful transplant. The hand therapy journey will begin before surgery by meeting with the hand therapy team. They will assess the patient’s extremities and will begin to formulate a custom therapy plan unique to the individual. Following the surgery, therapists will see the patient in the hospital and will begin gentle range of motion exercises. They will also make custom splints to protect the newly transplanted hand and arm. Following discharge from the hospital, patients will stay locally for 3-6 months to undergo an extensive hand therapy protocol which will take palace 3-6 hours a day, 5 days a week. After this, the patient will be transitioned to a hand therapy team closer to their home town for continued therapy. For more details on the hand therapy program click here.
How many hand transplants have been performed world-wide?
Close to 100 hand and arm transplants have taken place world wide as of Jan 1st, 2014.
What are the outcomes of hand transplantation?
Overall, the outcomes of hand and upper extremity transplantation have been very promising. Most patients experience one or more episodes of acute rejection of the hand, however these are treatable with medications and are not thought to be detrimental to the transplant. All patients recover some degree of sensation or the ability to feel things again. Most patients also regain good function of the hand and arm and are able to complete normal activities of daily living and independent self care. Patients also experience a sense of wholeness again after receiving a hand transplant. The majority of hand transplant patients are able to return to work and to complete hobbies once again. For more details on hand transplant outcomes click here.
What are the costs of a hand transplant at SIU?
All pre-transplant screening tests, the procedure itself, and post-operative care including rehabilitation and 3 months of medications are covered by the hand transplant program. It will be necessary for the patient’s health insurance provider to cover the costs of life-long medications and some aspects of follow-up care.
What are the potential side-effects from hand transplantation?
Because hand transplantation is similar to other organ transplants and requires immunosuppression (anti-rejection) medications, there are a number of potential risks and side effects. In order to prevent the immune system from attacking the transplanted tissue, medications that lower the immune system are used that also make patients more susceptible to infections (viral illnesses, pneumonia, skin infections), metabolic problems (like diabetes), and some cancers. There are also risks that come with any surgical procedure such as allergic reactions to anesthetics, excessive scaring, infections, blood clots in the legs that can move to the lungs, heart attacks, and strokes. Although very rare, some of the complications can be life threatening.
The Institute for Plastic Surgery at Southern Illinois University School of Medicine is a regional hand, burn, and plastic surgery center that has a rich history of hand/upper extremity replantation and salvage. Because of the large farming community in the surrounding region, SIU treats a number of mutilating hand injuries, including amputations, on a regular basis. Replantation, or the processes of re-attaching a severed finger, hand, or arm is always our goal, however, some times this is not feasible such as when the amputated part is too damaged, or it has been without blood flow for too long.
Hand transplantation is similar to replantation in many ways, and our experience with replantation makes us uniquely qualified to offer hand transplantation. The Department of Surgery also has a history of excellence in solid organ transplantation beginning with Dr. Alan Birtch who was a fellow of Dr. Joseph Murray, a Nobel Prize laureate for performing the first kidney transplants.
Who should I contact for further questions about hand transplantation at SIU?
Jennifer Koechle, MPH, CCRP
Hand Transplant Clinical Research Coordinator
Local Number - 1-217-545-7014
Toll free - 1-855 SIU-HAND (1-855 -748-4263)