Nation's First Bilateral Hand Transplant Recipient Speaks About Surgery And Progress

Main Category: Transplants / Organ Donations
Article Date: 20 Jul 2009 - 5:00 PDT

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Jeff Kepner, the nation's first bilateral hand transplant recipient, spoke at a news conference today about his surgery and showed the progress he has made since the May 4 procedure. Mr. Kepner, who lost both hands and feet following a bacterial infection in 1999, is the second patient to be treated with the "Pittsburgh Protocol," a new immune modulation therapy that aims to reduce the risk associated with toxic anti-rejection drugs.

"I am looking forward to the opportunity to regain my independence. It will be great to hold my wife's and daughter's hands again and to be able to do things with them that I haven't been able to do for over 10 years," said Mr. Kepner, 57, of Augusta, Ga.

A transplant team composed of surgeons, hematologists, nurses, therapists and researchers has cared for Mr. Kepner since the nine-hour surgery. He receives daily occupational therapy at UPMC as his physicians monitor him closely for signs of rejection.

"This ground-breaking surgery represents the culmination of more than 20 years of research in the field of hand transplantation," said W.P. Andrew Lee, M.D., chief of the Division of Plastic and Reconstructive Surgery and leader of the UPMC hand transplant surgical team. "Thus far, Jeff is meeting our expectations for recovery. He is making steady progress in hand therapy, and we expect him to regain movement and sensation in the transplanted hands in the next nine to 12 months as he works with a team of occupational therapists."

Although surgeons from around the world have performed hand transplants successfully, they have used a traditional 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 bone marrow cell therapy. The goal is not merely to suppress the immune system but to change the way it functions. Under the protocol, Mr. Kepner received antibodies to help overcome the initial overwhelming immune response. That was followed by a bone marrow infusion from the hand donor 15 days after the surgery. 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 two decades ago to maintain the low-grade immunosuppression needed to prevent long-term graft rejection.

"Unlike a solid-organ transplant, which is needed to sustain or prolong life, a hand transplant enhances the quality of life," said Dr. Lee. "We have devoted many years of research to developing an immunomodulatory protocol that may reduce the risks of the procedure for the long-term health of our patients. This would allow more amputees to be considered for hand transplants in the future. Currently, we have three people approved for hand transplants awaiting suitable donors."

UPMC and the Armed Forces Institute of Regenerative Medicine (AFIRM) are funding the hand transplant study. Surgeons performed the first unilateral hand transplant at UPMC on March 14, 2009.

For more information on the hand transplant program, including photos and video of Mr. Kepner's surgery and hand therapy, please visit http://www.upmc.com/handtransplant.

Source
UPMC