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World first hand transplant for patient disabled by Scleroderma The Hand Transplant team at Leeds Teaching Hospitals performed the world’s first hand transplant in a patient whose hands were completely disabled by the rare disease scleroderma, potentially opening a whole new area of intervention for people with the condition. Scleroderma is an autoimmune disease that causes scarring of the skin and internal organs. In some cases the hands can become badly affected, with the fingers completely locked in a fist position, meaning sufferers are unable to use their hands. The Hand Transplant team at Leeds Teaching Hospitals removed the patient’s own hands and then undertook a successful double hand transplantation on 48-year-old Steven Gallagher from Ayrshire, whose hands had been afflicted by scleroderma for years, replacing his hands with the hands of a donor. It is the first time anywhere in the world that hand transplantation has been used to replace hands terminally affected by scleroderma. The procedure went well, and Steven remained in Leeds General Infirmary over the holiday period in December before being discharged back to Ayrshire. Patient Steven said: “About seven years ago my scleroderma caused the skin on my hands to get tighter and my fingers started curling in. Although different treatments were tried, my fingers were scrunched into my hands and I could only use my thumbs. It was very painful and a lot of pain relief was required - the pain was unbelievable at times. I had to stop work as a roof tiler after 23 years. “When the hand transplant was first mentioned I thought it sounded farfetched, but I couldn’t use my hands at all at this point and I felt I had nothing to lose. I wasn’t put off by the risk of losing my hands as they were getting so much worse and it was like not really having hands at all.” LTHT is one of the national centres for the treatment of scleroderma under the direction of Professor Francesco Del Galdo. Professor Del Galdo said: “A few years ago I spoke at a conference in Glasgow explaining how plastic surgery can sometimes help to increase hand function
Patient Steven Gallagher, photo copyright PA Media
for the relatively small number of people suffering this type of scleroderma. Steven, who was at the talk, got in touch with Professor Andy Hart in Glasgow to see if anything could be done to help restore his hands. The Glasgow team worked with Steven and referred him to the Leeds team who are the UK’s only Hand Transplant Service, as the damage to Steven’s hands was too advanced for any simple restorative surgery.” After two years of complex evaluation and preparation by the team in Leeds under the direction of Professor Simon Kay, a donor for Steven was found with hands that were the right immunological match, gender, size and skin tone. The surgery involved a thirty-strong team of professionals from many disciplines. Professor Kay paid tribute to the team saying: “This operation has been a huge team effort with input from our colleagues here in Leeds and in Glasgow. Having a hand transplant is very different from a kidney or other organ transplant, as hands are something we see every day and we use them in so many ways.” Five months since the operation, Steven
has found his new hands to be much more responsive. He said: “I’ve got much more movement now than I had - I can move all my fingers. I’m exercising them and stretching them. I go to the physio twice a week, and I feel like the hands are a part of me. When I was operated on, I had hands and I came around with hands, so it’s as if they fixed the hands I had. Now, around five months after my double hand transplant, I can move my fingers and thumbs and also move my wrists. I had so much more movement after just six weeks than I had before the operation and my pain score has gone to zero.” Professor Kay added: “We would particularly like to thank the donor’s family who made the brave and generous decision to donate, and the senior nurses in organ donation who have the difficult task of approaching families at the height of their grief to propose donation. So many unsung heroes play vital roles in such complex care.” The Leeds Team have now carried out 14 hand transplants in eight patients, one of the busiest and most innovative of such services in the western world.
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