Monday, December 13, 2010

New Technology May Help Prevent Rejection in Hand Transplant Patients

Previously I posted on rejection in hand transplant patients when it was reported double hand transplant on patient Rich Edwards of Oklahoma might “lose the fingertips on his right thumb and pinkie because his body started to reject the new limbs.”

Jewish Hospital Hand Care Center and the Christine M Kleinert Institute have released news on a new medical device which may allow detection of rejection at an earlier stage.  Early detection could then improve treatment and perhaps prevent limb loss as with the team’s 4th patient Dave Armstrong who had his transplanted hand amputated in April 2009 due to rejection.

I first read about this new device, an ultrasound biomicroscopy device, in Wave3.com’s December 6, 2010 article: New technology helping keep transplanted hands attached.  Today I found the December 9, 2010 press release from the team (bold highlight is mine).

Despite recent setbacks, Dr. Richard “Rich” Edwards, the nation’s third double hand transplant recipient, continues to progress under the care of Kleinert Kutz and Associates hand surgeons at Jewish Hospital in Louisville, Ky.

Dr. Edwards experienced complications in mid-November when signs of rejection caused him to be hospitalized for several days.  Michael Marvin, M.D., chief of transplantation, Jewish Hospital/University of Louisville, and Rosemary Ouseph, MD, director of kidney transplantation at University of Louisville, who have overseen Edwards’ post-surgical immunosuppressant drug regimen, added steroid shots to Dr. Edwards’ routine to counteract the rejection.

The complication, which resulted in a loss of blood flow has caused the tip of Dr. Edwards  right pinkie to turn black. He had already had the tip of the thumb turn black due to a loss of blood flow shortly after the transplant. Unfortunately, those fingertips may eventually need to be removed.

Dr. Warren Breidenbach, partner at Kleinert Kutz  and Associates and assistant clinical professor of surgery at the University of Louisville said, “ The left hand is doing great and has good function. I call the right hand the “miracle hand” because of blood flow issues early on. The good news about the right hand is it has re-established blood flow and his hand function has almost caught up with the left hand.  The bad news is the right hand does not have the same volume of blood flow as the left, but it does have enough to survive.  The right hand remains a problem hand with an unknown future.  We are in uncharted waters with the right hand.”

Breidenbach added, “All hand transplant patients have the risk of loosing a hand at any time. In addition, all patients go through a rejection episode in the first six months. Dr. Edwards was around three months out from the transplant.  He had swelling which compromised the blood flow in mid November.“

Dr. Edwards remains closely monitored by the team at the Christine M. Kleinert Institute for Hand and Microsurgery (CMKI), including Christina Kaufman, PhD., executive director of CMKI and assistant professor at the University of Louisville.  Dr. Kaufman uses ultrasound biomicroscopy (UBM), a new technology that utilizes very high frequency ultrasound (20-70 MHz) to noninvasively monitor blood flow, vessels, arteries and artery intima, or thickness, which is where signs of potential rejection often first appear.

The device, which has not yet been approved for clinical use, was purchased with funds from the Department of Defense in January 2010.  Each of the previous hand transplant patients are also being monitored using UBM. Currently, Dr. Edwards is being tested every two weeks.

“Using this new technology we have done a great deal of investigation,” said Kaufman.  “There is a push to reduce the immunosuppressant medications, but we do not want to risk the loss of the hand.  With this machine, we are hoping to be able to reduce the drug regimen with maximum safety.  We are making advances and we’re getting better. That’s what research is about.”

Dr. Edwards continues therapy on his hands five-days-a-week with the therapists at the Christine M. Kleinert for four-hours-a-day. His wife, Cindy Edwards, assists him with additional therapy on his own several times each day, seven-days-a-week. His hands have already helped him regain independence in his daily activities.  He can brush his teeth, comb his hair, take his shirt on and off and feed himself throughout an entire meal – all activities that he was unable to do unaided before the transplant.  He hopes to be able to return to his home in Edmond, Oklahoma for the holidays.

“Every one to two days, I can see a change in my hands,” said Dr. Edwards.  “They are the best Christmas gift that I have ever been given.”

“These are minute changes, but when you work with his hands all day every day, those changes are encouraging,” said Cindy Edwards.  “He’s come a long way in less than four months.”

Dr. Edwards worked as a chiropractor before losing both hands when his truck caught fire on February 11, 2006.  Unable to escape the burning vehicle, he was severely burned on his face, back, arms and hands, leaving very little tissue in both hands.

Dr. Breidenbach led the team of surgeons from Kleinert Kutz, Christine M. Kleinert Institute and the University of Louisville who performed the initial 17 ½ hour surgical procedure August 24-25, 2010, at the Jewish Hospital Hand Care Center.  He continues to manage Dr. Edwards’ follow-up care.

The Composite Tissue Allotransplantation program is a partnership of physicians, researchers and healthcare providers at the Jewish Hospital Hand Care Center, Kleinert Kutz and Associates, the Christine M. Kleinert Institute and the University of Louisville. The group developed the pioneering hand transplant procedure and has performed five other hand transplants since 1999.  Kentucky Organ Donor Affiliates coordinated the hand donation for the team’s hand transplant procedures.

The hand transplant is sponsored by the Department of Defense, Office of Naval Research and Office of Army Research to further research in the composite tissue allotransplantation program.

Patient and physician information, photography and video are available at www.handtransplant.com and http://www.jhsmh.org/hand

1 comment:

Javier Rojas said...

Hi Dr. Bates:

My name is Javier Rojas Villa. I am a 2nd year-medicine student at Universidad Católica del Maule, Talca, Chile.

First of all, I appreciated all the efforts to have updated this blog, because it is very useful for the medicine students, colleagues and general public to be informed about medical stories and medical issues. Something that it is very interesting is your hobby of sewing and quilting that it has a relation with your job as a plastic surgeon. Medicine is an art, as it is working with fabric.

I liked the post that you wrote in the blog about "New Technology May Help Prevent Rejection in Hand Transplant Patients". It is an important research for all the people that have rejection in some part of their body. It must be, unfortunately, an expensive treatment and not all the people will have the opportunity to have that solution. But I hope, in a near future, all patients will have that possibility.

Greetings from Chile,