Frequently Asked Questions About Reconstructive Transplantation
What is reconstructive transplantation?
Reconstructive transplantation is the umbrella term for transplants composed of multiple tissues, like the hand.
How are reconstructive hand transplants performed?
Hand transplantation is complex because the human hand consists of 27 bones, 28 muscles, 3 major nerves, 2 major arteries, and multiple tendons, veins, and soft tissue.
Surgery can last from eight to 10 hours or more and involves:
- Bone fixation
- Reattachment of arteries and veins
- Repair of tendons and nerves
How many hand transplants have been performed in the United States and worldwide?
Who is on the UPMC Reconstructive Transplant team?
Who can participate in the UPMC hand transplant study?
What is rejection after reconstructive transplantation?
Rejection refers to the body’s immune response towards the newly transplanted hand.
Believing the tissues to be “foreign,” the body’s natural response is to attack. This can occur within days to months after transplant.
How is rejection detected or diagnosed in hand transplants?
For hand transplants, rejection:
- Almost always appears first in the skin, anywhere on the transplant
- May appear as a rash that is spotty, patchy, or blotchy
- Is usually painless
Unlike internal organ transplants, where rejection is difficult to spot early, it's easy to detect and monitor in the hands, allowing for early medical intervention.
Transplant recipients should carefully watch for signs of rejection, and immediately report them to their physicians for timely biopsy and treatment.
How many hands have been lost to rejection?
To date, only one patient in the world is known to have lost a transplanted hand to suspected rejection, despite appropriate medication.
How is a donor hand selected for transplantation?
In contrast to the case of identifying a solid-organ donor, selecting a donor for a hand transplant must involve additional and careful emphasis on matching:
- Skin color and tone
- Ethnicity and race
- Hand size
What is therapy like after hand transplant surgery?
Patients are encouraged to start moving the hand early — within 24 to 48 hours after surgery — to reduce edema and stiffness.
Therapy after hand transplant is long and intensive. Patients are educated, before surgery, on the critical importance of rehabilitation in improving functional outcome after the procedure.
What is the current status and future of reconstructive transplantation?
In the last decade, around 80 different reconstructive transplantation surgeries have been performed with success.
Since its inception, reconstructive transplantation has faced and endured much speculation, debate, controversy, and scrutiny. Early world outcomes have confirmed that satisfactory to excellent function can be achieved with these types of procedures.
The goal now is successful avoidance of the risks of high-dose multiple drug therapy to prevent rejection.
Realization of such protocols in clinical reconstructive transplantation will herald a new era of reconstructive transplant surgery to treat complex and major tissue defects.