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Surgeons perform world's first pediatric bilateral hand transplant

Surgeons in Philadelphia, PA, recently completed the world’s first bilateral hand transplant on a child. The surgical team successfully transplanted donor hands and forearms onto 8-year-old Zion Harvey.

A 40-member multidisciplinary team of physicians, nurses, and staff—from departments of plastic and reconstructive surgery, orthopedic surgery, anesthesiology, and radiology—participated in the operation, which took place at Children’s Hospital of Philadelphia (CHOP). Surgeons from CHOP, Penn Medicine, and Shriners Hospitals for Children in Philadelphia collaborated during the 10-hour surgical transplantation.

“This surgery was the result of years of training, followed by months of planning and preparation by a remarkable team,” said L. Scott Levin, MD, chairman of the Department of Orthopaedic Surgery at Penn Medicine and director of the Hand Transplantation Program at CHOP, who led the surgery. “The success of Penn’s first bilateral hand transplant on an adult, performed in 2011, gave us a foundation to adapt the intricate techniques and coordinated plans required to perform this type of complex procedure on a child.”

Due to a serious infection when he was younger, Zion had undergone amputation of his hands and feet, as well as a kidney transplant. He was initially referred to Shriners Hospitals for Children because of its expertise in pediatric orthopedic care. Through a coordinated effort between Shriners Hospitals for Children and CHOP, Zion was evaluated as a possible recipient of the first pediatric hand transplant.

Double hand transplantation is a complex procedure involving many surgical and non-surgical components. First, the potential recipient must undergo extensive medical screenings and evaluations before surgery. In this case, the patient’s previous medical condition, following sepsis at an early age, factored into the decision to perform the transplant. “Zion’s kidney transplant following his infection made him a candidate for transplant because he was already taking anti-rejection medication,” said Benjamin Chang, MD, co-director of CHOP’s Hand Transplant Program as well as associate chief of the Division of Plastic Surgery at Penn Medicine.

The surgical team was divided into four simultaneous operating teams—two focused on the donor limbs and two focused on the recipient. First, the radius and ulna were connected with steel plates and screws. Next, microvascular surgical techniques were used to connect the arteries and veins. Once blood flow was established through the reconnected blood vessels, surgeons individually repaired and rejoined each muscle and tendon. Surgeons then reattached nerves and closed the surgical sites.

Postoperatively, Zion spent a week in CHOP’s Pediatric Intensive Care Unit and then moved to a medical unit. He is now in the inpatient rehabilitation unit, where he undergoes rigorous hand therapy several times each day. He continues to receive daily immunosuppressant medications to prevent his body from rejecting the new limbs, as well as his transplanted kidney.

The clinical team expects Zion to spend several more weeks in CHOP’s rehabilitation unit, and then to be discharged to his home in Baltimore, MD. Dr. Levin and his team will continue to follow him monthly in the short-term and then annually throughout his lifetime.