UCLA Health System launches groundbreaking program in limb transplants for amputees

The UCLA Health System launched a new hand transplantation program last week, one of three others in the United States and the only one of its kind on the West Coast.

The new program, which is currently in the process of recruiting candidates for surgery, aims to further develop the practice of transplanting a bodily limb from a donor to a patient who has suffered from a traumatic loss of limb.

“The reason that we decided to start the program was that we thought there was a real need to bring hand transplantation forward in the United States,” said Dr. Sue McDiarmid, professor of pediatrics and surgery and the medical director of the new program.

While the techniques of reattaching amputated limbs and transplanting organs from donors to patients have been around for many years, the combined process of transplanting limbs is just gaining ground. Currently, nine patients have received hand transplantation in the United States, with a total of 11 hands transplanted.

“Initially we used to perform transplants in order to save one life; the kidney, lung and heart are all lifesaving transplants,” said Dr. Kodi Azari, associate professor of orthopedic surgery and plastic surgery and the surgical director of the hand transplantation program. “Yet now we are switching. We have learned from those techniques and now we are trying to establish transplantation in order to improve one’s life.”

The shift in the use of transplantation as a life-saving function toward improving a patient’s life is a main goal of the program. The program is seeking candidates who have difficulty living their normal lives with amputated limbs and cannot adapt to the use of prosthetic devices.

Through the use of a hand transplantation, the doctors of the new program aim to help those who have suffered traumatic injuries, from car accidents, work-related accidents or military conflicts, regain the function and use of their hands.

With the continuation of military engagements by the United States, the number of such traumatic injuries has been growing, Azari said.

“We have two conflicts that we are currently involved with and there is a significant number of our wounded heroes coming back that are missing limbs,” Azari said.

The surgery to reattach a hand can last 8 to 14 hours, requiring as many as 14 surgeons, and it can take several years for a patient to fully regain acceptable movement and sensation. The process involves experts from a wide range of medical specialties including plastic and reconstructive surgery, orthopedic surgery, psychiatry, neurology, anesthesia and rehabilitation.

“To transplant the hand requires the reattachment of two bones, three nerves, two arteries, four to six veins and somewhere around 23 tendons,” Azari said.

In addition to the complex surgery required, the hand transplantation program is also seeking to test and develop the use of existing immune-suppressing drugs in the reattachment of the hand.

The anti-rejection drugs are used to ensure that the transplants are accepted by the patient’s body, but excessive use can hinder the patient’s immune system. There is little experience with the use of these drugs in the transplantation of limbs, although they are commonly used in organ transplantation.

“We are at the forefront of a brand new frontier in medicine,” Azari said.

“If we can figure out how to manage the immunosuppression medication to use them minimally, safely, effectively and with as little consequence to the patient, we will enter a brand new frontier in medicine called reconstructive transplantation surgery.”