When Rene Chavez of Laredo, Texas, was 4 years old, he lost his left hand in an accident. Last Wednesday, almost 50 years later, he flexed the fingers on a new left hand provided by surgeons at Duke University Hospital.
The surgery, the first of its kind in North Carolina, was the culmination of years of planning and the development of drugs to ensure the transplanted hand will not be rejected by Chavez’s immune system.
Dr. Linda Cendales, who is building a new Hand Transplantation Program at Duke, said she “prefers to consider this the beginning” of an advanced surgical program funded by the U.S. Department of Defense in hopes of providing functional human limbs to injured servicemen and women as well as civilians.
Once Chavez was prepared for the procedure, a donor match was found within a week, and surgery took place May 27. Speaking through an interpreter at a news conference last week, Chavez said he’s looking forward to having full use of his dominant hand.
The multistage, 12-hour procedure was performed by a team of 17 surgeons and 17 anesthesiologists, nurses and operating room staff and technicians.
A pair of surgeons connected the donated bones to those of Chavez’s forearm with metal brackets, then other pairs stitched together the blood vessels, tendons, muscles and skin. During his recovery, Chavez’s nerves will creep about 1 inch per month into his new hand like roots in a growing tree, according to Dr. David Ruch, head of Duke’s Hand Surgery Division. The surgery will be considered successful when Chavez’s nerve endings reach the tips of his new fingers.
The surgical team was brought together by Dr. Allan Kirk, chairman of surgery at Duke, and led by Cendales, who helped establish the first hand transplant program in the U.S. at a surgery institute in Louisville, Kentucky, before coming to Duke in 2014.
The surgery is just one of the innovations developed to give Chavez his new hand. He is being treated with a new anti-rejection drug, which the team hopes will allow his body to accept the foreign limb. Standard anti-rejection medication used after a transplant completely suppresses a patient’s immune system, Kirk said, increasing the risk of infection in a patient already vulnerable after such invasive surgery.
The Duke team’s drug will “train” Chavez’s immune system to recognize the transplanted hand as a familiar part of his body and refrain from attacking it. Kirk said the concept for the drug was inspired by autoimmune disorders that pass under the radar of an infected immune system, and how a pregnant woman’s antibodies know not to attack the foreign fetus she is carrying.
Chavez lost his left hand when he reached into a meat grinder and his brother accidentally turned it on. He worked as a car dealer in Laredo until he learned about the possibility of regaining a hand on the internet and found the program at Duke. Now, Cendales says, “rehabilitation is his full-time job.”
Chavez has already begun the long process of physical therapy to explore using his left hand. He also will meet with therapists to process the complex emotions involved with relearning life after spending most of it with one hand. Ruch explained that the way Chavez’s brain will learn how to use his new hand can be helpful to clinicians who treat stroke victims who have lost the use of one side of their bodies.
Chavez is only one of 90 people to undergo a hand transplant worldwide. The gravity of the chance he has been given is not lost on him. He expressed sympathy to the anonymous donor’s family and says he is grateful to the surgical team and “especially for the care given” to him at Duke since the surgery.
Cendales and the Hand Transplantation Program have Defense Department funding for more trial transplants and will be looking for more patients to participate.