World first hand transplant for patient disabled by Scleroderma
26 May 2022
The Hand Transplant team at Leeds Teaching Hospitals has performed the world’s first hand transplant in a patient whose hands were completely disabled by the rare disease scleroderma, potentially opening a whole new area of intervention for people with the condition.
Scleroderma is an autoimmune disease that causes scarring of the skin and internal organs. In some cases the hands can become badly affected, with the fingers completely locked in a fist position, meaning sufferers are unable to use their hands.
The Hand Transplant team at Leeds Teaching Hospitals removed the patient’s own hands and then undertook a successful double hand transplantation on 48-year-old Steven Gallagher from Ayrshire, whose hands had been afflicted by Scleroderma for years, replacing his hands with the hands of a donor.
It is the first time anywhere in the world that hand transplantation has been used to replace hands terminally affected by scleroderma.
The procedure went well, and Steven remained in Leeds General Infirmary over the holiday period before being discharged back to Ayrshire.
Steven says: “About seven years ago my scleroderma caused the skin on my hands to get tighter and my fingers started curling in. Although different treatments were tried, my fingers were scrunched into my hands and I could only use my thumbs. It was very painful and a lot of pain relief was required - the pain was unbelievable at times. I had to stop work after 23 years. I started as an apprentice roof tiler, completed my apprenticeship after four years and then got my own squad. I was made assistant contracts manager but unfortunately due to the severity of my hands and being in so much pain all the time, I had to call it a day.
“When the hand transplant was first mentioned I thought it sounded farfetched, but I couldn’t use my hands at all at this point and I felt I had nothing to lose. I talked to Kerry my wife about it, and I spoke to Professor Hart in Glasgow and Professor Kay in Leeds. I also had a psychological evaluation to make sure I was taking the right decision to try for the hand transplant. But I wasn’t put off by the risk of losing my hands as they were getting so much worse and it was like not really having hands at all.
“I’ve got much more movement now than I had - I can move all my fingers. I’m exercising them and stretching them. I go to the physio twice a week, and I feel like new the hands are a part of me. When I was operated on, I had hands and I came around with hands, so it’s as if they fixed the hands I had. Now around five months after my double hand transplant, I can move my fingers and thumbs and also move my wrists. I had so much more movement after just six weeks than I had before the operation and my pain score has gone to zero.
“The hardest thing was being away from home in Leeds for the operation but I’d said to the family not to come down because of Covid. We were able to stay in touch over video calls and we could open Christmas presents. My three daughters have been so helpful - they’ve always been there for me and were 100 present behind me. The hospital staff were brilliant - I couldn’t have asked for anything more from them. They even got me a Christmas tree! But I am so grateful to the person and family of the donor who made this possible.”
Leeds Teaching Hospital NHS Trust is one of the national centres for the treatment of scleroderma under the direction of Professor Francesco Del Galdo.
Professor Del Galdo said: “A few years ago I spoke at a meeting in Glasgow organised by the scleroderma charity SRUK. There I mentioned that plastic surgery can sometimes help to increase hand function for the relatively small numbers of people suffering this type of scleroderma. Steven, who was at the talk, got in touch with the team of plastic surgeon Professor Andy Hart in Glasgow to see if anything could be done to help restore his hands.
“The Glasgow team worked with Steven and referred him to the Leeds team who are the UK's only Hand Transplant Service, as the damage to Stephen’s hands was too advanced for any simple restorative surgery.”
After two years of complex evaluation and preparation by the team in Leeds under the direction of Professor Simon Kay, a donor for Steven was found with hands that were the right immunological match, gender, size and skin tone.
The surgery involved a thirty-strong team of professionals from many disciplines. Professor Kay paid tribute to the team saying: “This operation has been a huge team effort with input from our colleagues here in Leeds and in Glasgow. Having a hand transplant is very different from a kidney or other organ transplant, as hands are something we see every day and we use them in so many ways.
“For this reason we and our expert Clinical Psychologists assess and prepare patients, to be sure that they will be able to cope psychologically with the permanent reminder of their transplant, and the risk the body may reject the transplanted hands.
“We would particularly like to thank the donor’s family who made the brave and generous decision to donate, and the Senior Nurses in Organ Donation who have the difficult task of approaching families at the height of their grief in order to propose donation. So many unsung heroes play vital roles in such complex care.”
Sue Farrington, Chief Executive of SRUK said: “SRUK are delighted to hear that Steven’s hand transplant has been successful and we wish him all the best for his recovery. It is wonderful to have been a small part of this process, and to know that SRUK conferences and talks continue to have an impact years later.”
The Leeds Team have now carried out 14 hand transplants in eight patients, one of the busiest and most innovative of such services in the western world.