A Bowling Green, Kentucky, man is the ninth patient to receive a hand transplant by the Louisville Vascularized Composite Allograft (VCA) surgical team at Jewish Hospital.
The 16-hour procedure involved 26 surgeons and took place on November 25. The hand transplant recipient, Jim Ray, is recovering and resting comfortably at the hospital. A new companion study will test whether cells isolated from the patient’s own fat will modulate the immune system and reduce the amount of drugs needed to prevent rejection, and results of this trial will be far-reaching and benefit all hand transplant recipients.
The 67-year-old hand transplant recipient injured both hands in an accident when he lost control of his car during a test drive at a race track on July 20, 2012. His right hand was amputated and left hand was de-gloved at the wrist during the accident. Surgeons were able to save his left hand, but not the right.
A new companion study will test whether cells isolated from the patient’s own fat will modulate the immune system and reduce the amount of drugs needed to prevent rejection, and results of this trial will be far-reaching and benefit all hand transplant recipients.
Mr Ray, who is right-handed, used a hook-type prosthesis for his right hand and needed help with many of the activities of daily living. “This is the first patient where our team has had to do an amputation,” said Tuna Ozyurekoglu, MD, hand surgeon with Kleinert Kutz Hand Care Center. “This makes it so special for us, and such a rewarding moment, because we are able to give him a new hand,” he said.
“He is doing great, looks great, and is very motivated for his upcoming therapy. This amputation was close to the elbow, so we will rely on nerve regeneration more on this patient than in previous cases. We’re hopeful that the use of these stem cells will help speed up the nerve regeneration. We are hopeful that he will have a fully functional hand,” he said.
“Without the donor and donor family, we wouldn’t be able to do any of this,” said Michael Marvin, MD, director of transplantation at Jewish Hospital and associate professor of surgery at the University of Louisville. “This is the first national share for vascularized composite allotransplantation, and it shows how transplant organizations across the country are dedicated to the work we’re doing with the Louisville VCA team.
“We haven’t seen any complications at this point with Mr Ray’s transplant, and we are continuing to monitor his immunosuppression (anti-rejection drug) therapy,” Marvin added.
The patient’s immune system will be suppressed with a combination of drugs. A team of physicians from Jewish Hospital, University of Louisville and Kleinert Kutz will closely monitor the patient for signs of rejection and adverse reaction to medications with lab tests and biopsies.
New SVF Cell Treatment May Improve Healing, Prevent Rejection
In a collaboration with the Louisville VCA Program, Stuart K. Williams, PhD, director, Bioficial Organs Program, and James B. Hoying, PhD, chief, division of Cardiovascular Therapeutics, both with the Cardiovascular Innovation Institute, stromal vascular fraction (SVF) cells will be isolated from the patient’s fat and injected into the new hand. The patient will receive the same care as any other hand transplant recipient, and his progress will be monitored to see if the amount or severity of rejection is reduced by the SVF cell treatment.
“With this research model, the patient’s own fat cells are removed from the body and then immediately processed and injected into the hand. It is our hope and desire that this study will improve tissue response, dramatically impact healing, and reduce need for immunosuppression in patients like Mr Ray,” Williams said.
The Louisville VCA team was awarded $850,000 to fund the clinical trial for the new treatment that will help prevent rejection in hand transplantation. The funding comes as part of the Armed Forces Institute of Regenerative Medicine (AFIRM) research program. AFIRM II is a 5-year, $75 million Department of Defense-funded project that will focus on applying regenerative medicine to battlefield injuries.