Hand Transplant
Hand Transplant
Composite Tissue Allotransplantation
As composite tissue allotransplantation (CTA) progresses from its investigational status to a standard-of-care option for persons with traumatic amputations and disfiguring injuries, civilian and military healthcare providers require access to the scientific advancements of this field. The current military actions in the Middle East demonstrate that, although protective equipment and the early, skilled response to injuries have saved more lives than in past conflicts, the exposure to improvised explosive devices has increased the frequency of devastating limb and facial damage. The resulting injuries have increased the number of soldiers requiring amputee and rehabilitation services. CTA can address the physical and psychological health of some of these soldiers in a way that allows them to remain in the military or pursue other productive career goals without the limitations imposed by a prosthetic device.
Understanding the mechanisms required to reduce the incidence of organ rejection while concurrently reducing the need for immunosuppressive drugs will make CTA a more viable and acceptable technique. When this technique is refined to promote tolerance, the side effects and cost of immunosuppressive medications may no longer be problematic for recipients. It is this goal—to improve the physical and psychological health of amputees by making CTA more viable—that led to a partnership of physicians and researchers at Kleinert Kutz, the University of Louisville, and the Jewish Hospital Hand Care Center. Through this partnership, a composite tissue allotransplantation program was developed, pioneering the world's first successful hand transplant in 1999 and the nation's second in 2001. Based on this tremendous success, in October of 2004, Sen. Jim Bunning (R-KY) announced a $2.5 million contract award from the Department of the Navy to this distinguished group of surgeons and researchers.
The work supported by the grant from the Office of Naval Research (ONR) began October 15th, 2005 and runs through August 29th, 2007. Since acquiring this grant, the partnership of Kleinert Kutz, led by Dr. Warren Breidenbach, together with the University of Louisville Institute for Cellular Therapeutics, directed by Dr. Suzanne Ildstad, and the Jewish Hospital Hand Care Center have accomplished the following:
- Developed and maintained a research-based team for the hand transplant program including protocols, IRB applications, case reports, and algorithms for the entire spectrum of evaluation, surgery, care, and outcomes.
- Organized, educated, and managed the hand transplant team (surgeons, anesthesiologists, OR nurses, administrators, pharmacists, lab and tissue typing personnel, media relations staff, and professionals to handle in-patient and out-patient hospital care: out-patient physical therapists, social workers, psychiatrists, and others) in preparation for the hand transplant.
- Recruited and evaluated potential candidates for a hand transplant, which included the evaluation of the amputations, medical screening, tissue typing, psychological evaluations, social evaluation, etc.
- Developed and incorporated a strong and ongoing relationship with the Kentucky Organ Donor Association (KODA).
- Developed a steroid-sparing protocol for these patients, including the use of the medication Campath.
- Hosted the 6th International CTA Symposium in January 2006 that included over 100 leading researchers and surgeons in the field of Composite Tissue Allotransplantation (CTA) from the United States and around the world. The meeting evaluations were outstanding. As the world's first face transplant had just been completed six weeks earlier by a French team of surgeons who were in attendance—the event elicited national and international media coverage.
- Successfully completed a 16-hour hand transplant procedure, the nation's third, on November 29th, 2006.
- Provided, on an on-going basis, all follow-up medical care, including physical therapy and orthotics for the hand transplant patient.
- Obtained all appropriate data in case reports (including labs, biopsy reports, physical examinations, photos, physical therapy reports, psychological evaluations, etc) on an on-going basis for research purposes.
- Organized and directed the CTA Conference at the American Society of Reconstructive Microsurgeons (ASRM) in January 2007.
- Presented multiple abstracts, lectures, and panel presentations on composite tissue allotransplantation and hand transplantation at local, regional, national, and international scientific conferences.
- Submitted multiple CTA and hand transplantation manuscripts that have been accepted for publication.
- Participated in the Advanced Technology Applications and Combat Casualty Care (ATACCC) Conference with the branches of the Department of Defense in August 2006.
- Participated as a panel member at the Product Line Review for Trauma and Resuscitation for the Office of Army Research in January 2007.
For more information on Mr. Rickelman including photos and videos visit www.handtransplant.com.
