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Success for child double hand transplant

Wednesday July 19th, 2017

A child who received a double hand transplant is now able to carry out a range of tasks, 18 months on, it was announced today.

Member of the surgical team, Dr Sandra Amaral of the Children's Hospital of Philadelphia, USA, explains that similar transplants using donated hands have "become a burgeoning treatment option for adult amputees, there have been no successful cases previously reported in children".

In The Lancet Child & Adolescent Health today (19 July), the team describes the surgical and immunological, and the functional outcomes, of this operation involving bilateral hand and forearm transplantation in an eight-year-old boy, who had previously received a kidney transplantation.

They report: "Two years of extensive preparation by medical and surgical teams preceded the hand-forearm transplantation of this child."

Firstly the patient was immunosuppressed, then the operation was carried out by four teams working simultaneously on the donor and recipient limbs. It took just over ten hours. After a long hospital stay, close monitoring was carried out to measure the risk of tissue rejection. Eight episodes of tissue rejection occurred, all reversed with immunosuppression drugs.

"At 18 months, the child had exceeded his previous adapted abilities," the team reports. "As of 18 months after transplantation surgery he is able to write and feed, toilet, and dress himself more independently and efficiently than he could do before transplantation."

They add that he remains on four immunosuppressive medications. "Hand transplantation in a child can be surgically, medically, and functionally successful under carefully considered circumstances," they conclude.

Dr Amaral said: "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."

Amaral, S. et al. 18-month outcomes of heterologous bilateral hand transplantation in a child: a case report. The Lancet Child & Adolescent Health 18 July 2017; doi: 10.1016/S2352-4642(17)30012-31Articles [abstract]

Tags: Child Health | North America | Transplant

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