First Pediatric Bilateral Hand Transplant Performed

Robert Lowes and Laurie Scudder

July 28, 2015

Forty surgeons, anesthesiologists, nurses, and other clinicians at Children's Hospital of Philadelphia (CHOP) operated for 10 hours on an 8-year-old-boy earlier this month to achieve the world's first pediatric bilateral hand transplant.

The patient, Zion Harvey from Baltimore, Maryland, already is able to pick up a pizza crust with his new fingers. Zion hopes someday to swing on monkey bars, throw a football, and pet a dog.

CHOP announced the feat earlier today.

The surgical team was led by L. Scott Levin, MD, director of the hand transplantation program at CHOP, a professor of surgery at the Perelman School of Medicine at the University of Pennsylvania, and chair of the orthopaedic surgery department at Penn Medicine, an academic medical center. His collaborators included attending surgeons and other clinicians from CHOP, Penn Medicine, and Shriners Hospitals for Children-Pennsylvania.

The first adult hand transplant in the United States took place in 1999. A pediatric hand transplant is more challenging, in part because children have smaller blood vessels, and connecting them to the new appendage takes more skill, according to Dr Levin.

The first pediatric surgery of this sort occurred in Malaysia in 2000, when a baby girl born with a deformed left arm received the arm and hand of her identical twin sister, who had died at birth. The patient did not need immunosuppression therapy because the limb came from a genetically identical donor.

In contrast, Zion's operation represented the first pediatric hand transplant involving a genetically different donor. Such operations, which require lifetime immunosuppression and surveillance, are examples of vascularized composite allotransplantation.

Zion's hands and feet were amputated at age 2 years as a result of a life-threatening infection. Two years later, he received a kidney transplant from his mother. Because he was already receiving immunosuppression drugs, Zion was deemed a good candidate for a bilateral hand transplant.

L. Scott Levin, MD, who led the surgical team that performed the bilateral hand transplant for Zion Harvey, examining his patient before the procedure.

If anyone was ready to use a new set of hands, it was Zion. Walking and running through the world on prosthetic feet with cheerful exuberance, the precocious 8-year-old had learned to feed himself, write, play video games, and scroll down a smart phone screen like anyone else.

"I wasn't always like this," he said before the surgery without a hint of self-pity in a video produced by CHOP. "I'll be proud of what hands I get."

Dr Levin's surgical team planned and rehearsed a bilateral hand transplant for Zion for more than a year. Once a suitable donor was found, a platoon in scrubs sprang into action. Four sets of surgeons operated simultaneously: two focused on the donor limbs, and two on Zion's arms, which were amputated at the wrist. The first order of business was connecting the radius and ulna with steel plates and screws. Then came microvascular surgery to connect arteries and veins. Once Zion's new hands pinkened with the flow of blood, surgeons repaired and rejoined muscles and tendons, followed by nerves.

Now recovering in an inpatient rehabilitation unit, Zion is learning to use his new hands. His progress is promising.

"We have a strong belief that Zion will regain sensation and feeling in his hands," Dr Levin told Medscape Medical News. "He's using his own muscles to power the tendons in his new hand because the amputation level was at his wrist.

"We want Zion Harvey and children we hope like him in the future [who] receive hand transplants to enjoy the lives that other children and other human beings enjoy. That's the whole reason why we've done this, so that he can basically feel normal again and do the things like climb on the monkey bars and pet a dog with his hands.

"Those are our expectations and hopes."

More information on the operation is available on the CHOP website.

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