Finland performs 1st hand transplantation at HUS

Finland’s first hand transplantation was performed at Helsinki-Uusimaa Hospital District (HUS) Meilahti Bridge Hospital in November, said HUS in a press release on Wednesday.

The operation went as planned and the patient will be discharged soon.

The transplantation operation took about 17 hours.

“We transplanted one hand to a patient who has had both hands and legs amputated years ago,” said Jorma Ryhänen, professor and head physician in hand surgery.

A hand transplantation operation consists of three separate surgeries: detaching the hand from the donor, preparatory surgery of the recipient, and attaching the transplant.

During the attachment, the bones and blood vessels are connected first. Then, the tendons, nerves, and other structures are attached. There are dozens of different structures that need to be attached.

Globally, hand and arm transplantations have been done to the wrist-level and below or above the elbow. The operation is planned individually for each patient.

“The longer the recipient’s stump, the smaller the transplanted section needs to be, and the better the expected functional result. Our first patient's transplant was attached below the elbow,” Ryhänen added.

Before the transplantation, the patient underwent extensive examinations to find out if they are suitable for the operation.

After the surgery, the patient was in intensive care for about a week and on a general ward for several weeks. In future, the patient still needs to undergo rehabilitation, which will last over a year.

They will also have several follow-ups in the hospital to monitor function and sense of touch in the transplant, as well as the overall health of the patient.

The criterion for a successful transplantation is that function in the nerves and muscles recover.

“In wrist-level transplants, flexion and extension in the fingers recover usually fairly reliably. Sense of touch in the fingertips is also to be expected. However, grip strength, fine motor skills, and sensation will be poorer than in a normal hand. It is still too early to assess these in our patient’s case but so far everything seems good,” Ryhänen added.

The donor of a body part must be compatible with the recipient in many ways. In addition to tissue compatibility, the donor's sex, skin colour, and age need to be considered.

The first ever hand transplantation was performed in France in 1998.

In Western countries, nearly 200 vascularized composite allotransplantations (VCA) have been performed, and about 120 of them have been hand transplantations. VCAs are not life-saving procedures, but the aim is to significantly improve the patient's quality of life.

“The best functional results have been achieved in wrist-level transplantations where the patient's own, functional muscles in the forearm can move the fingers via the transplanted tendons soon after the surgery,” Ryhänen said.

Preparations for the first hand transplantation surgery in Finland were long. Led by Jorma Ryhänen, a team of hand, plastic, and transplantation surgeons, pathologists, anesthesiologists, nurses, and other specialists in various units have been preparing for the operation for several years.

HUS's surgeons practiced the operation on cadavers and visited other countries to learn about hand transplantations. The transplantation of one hand required two surgical teams.

“Hand transplantation requires a multitude of resources and deep knowledge of several medical specialties. A hospital needs to have established organ transplantation operations and a high-quality hand surgery unit to be able to perform hand transplantations. Now that the first hand transplantation has been successfully completed, the next step is to establish hand transplantations as part of the services HUS provides,” said Chief Medical Officer Markku Mäkijärvi.