In a procedure lasting 14 hours, a multidisciplinary team has completed Canada’s first upper limb transplant.
The surgery was led by Dr. Steven McCabe, director of the Hand Program at the University of Toronto division of plastic and reconstructive surgery, and included a team of 18 surgeons from both the University of Toronto and surrounding hospitals working on attached a forearm and hand matched from a donor to a patient who had been evaluated as a suitable candidate.
McCabe stressed the difficulty of the procedure but expressed optimism about future widespread use. “The procedure requires planning and co-ordination among many people. The surgical procedure itself is technically difficult and requires a team. The post surgical care is intense and there is the possibility of failure at any step along the way,” said McCabe. “We have the ability to do this type of transplant for patients who could be benefitted by it and anticipate there will be more patients in Canada. There are also other types of transplants such as transplantation of the face that are becoming feasible and we anticipate these will be available in the future.”
The 49-year-old patient, who has not been identified to protect her privacy, lost her arm below the elbow in an accident several years ago. She’s currently going through rehabilitation with a custom made splint and motion of the joints to avoid stiffness. The procedure, including pre-transplant, transplant and post-transplant phases for immune suppression and the prevention organ rejection, has been ongoing with cooperation from UHN's Multi-Organ Transplant Program, Toronto Western Hospital's Hand and Upper Extremity Transplant Program, and the Trillium Gift of Life Network (TGLN) that oversees the organ donation process.
“Recovery of function after upper extremity transplantation relies on nerve regeneration, and these nerves grow down the transplanted limb at a rate of about one millimetre per day,” said McCabe. “The muscles of the forearm would be the first to regain motion, perhaps a few months after surgery, but the ultimate functional recovery could take two years as the nerves make their way to the small muscles of the hand.”
Dr. McCabe was also part of the surgical team in Louisville, Kentucky that performed the world's first successful hand transplant in 1999. To date, over 110 hand transplants have taken place worldwide in more than 12 countries.