A Swiss man who lost parts of his arms and legs at 12 after a mismanaged infection led to sepsis and severe complications requiring amputation has received a double hand transplant in the United States – nearly 17 years later.
Hand transplants are rare: only 148 had been performed worldwide as of mid-2023, and not all were double transplants.
More than 20 people were involved in Luka Krizanac’s surgery at Penn Medicine – the University of Pennsylvania Health System – which lasted about 12 hours, and after years of practise.
CNN reports that for Krizanac, living without hands was more challenging than living without legs. Prosthetics he had simply couldn’t fill the need as well as the prosthetics he had for his legs, he said.
Krizanac was adamant about not letting his disability define him and maintained a positive outlook, but he and his family continued to search for ways to help improve his quality of life.
They pursued hand transplantation for years, but numerous obstacles, including insurance coverage and a lack of access to skilled providers, stalled progress.
In 2018, about a decade after he lost his hands, a series of fortuitous connections brought Krizanac from his home in Switzerland to Dr L Scott Levin’s office in Philadelphia.
Levin, Chair Emeritus of the Department of Orthopaedic Surgery and Professor of plastic surgery at Penn Medicine, said: “For various reasons, he was a superb candidate for hand transplant.”
But another set of challenges – including a global pandemic and wounds that had developed on Krizanac’s legs – delayed the process even further.
“During the pandemic, we had to put things on hold,” Levin said. “And because he had open wounds and skin breakdown (on his legs), he would have never been allowed to have his hand transplant, because the .. risk of infection … would have prevented us from proceeding.”
But Levin and a colleague flew out to Switzerland to treat his legs, diving into preparations for the hand transplant once back in Philadelphia while Krizanac healed.
Preparing for a double hand transplant generally takes about two years, barring other complications. But by late 2024, Levin and his team were ready. They had completed more than a dozen rehearsal sessions, mapping out the intricate steps needed to blend nerves, muscles, blood vessels and bones.
Krizanac moved to Philadelphia and did his best to enjoy his stay while anxiously awaiting an update.
The call came about two months later: there was a match. The Gift of Life, an organ donation programme, had found donor hands from a person who had the right skin tone, size and gender – a unique set of considerations that can make the match process more complex than some others.
A well-orchestrated team, comprising plastic surgery, orthopaedic surgery, transplant specialists, anaesthesia and nursing, worked concurrently on Krizanac and the donor.
After blood vessels were sutured together, circulation was monitored with various devices. Nerves take time to regenerate, so it was impossible to know in the operating room whether that part of the operation had been successful.
“We count on the nerves to regenerate, but that’s not assured. All we can do is technically do the best coaptation, the best nerve repair we can do … with incredible precision using the operating microscope,” Levin said. “With a little luck, if you will, and careful planning and execution of the operation, the nerves from the donor will grow into the muscles.”
Today, Krizanac is healing exceptionally well, Levin said. Nerves will continue to grow into his arms, and his recovery will continue to evolve over the next few years.
“The sensation, the ability to feel, improves. His strength improves. He starts to get back the fine muscles in the hand. He’s well on his way. Of all the transplant patients we’ve seen, his neural recovery has been the most accelerated.”
In addition to three or four physical therapy sessions each week, Krizanac is taking a few medications to help keep his body from rejecting the hands – a regimen similar to that of someone who had a kidney transplant. One of the medications, a calcineurin inhibitor called tacrolimus, has also been found to help with nerve regeneration.
Krizanac feels that he’s on a path toward regaining independence, too. About a month after his surgery, he was using his phone with his new hands. And while washing his hands a few months later, he was surprised when the feeling of cold water made him jump back.
Hand transplantation is considered an elective “quality of life” procedure, but Levin says there’s an obligation for the medical field to provide the same level of care and consideration for patients like Krizanac as there would be for someone who needs a liver transplant – as long as they are properly prepared and informed.
“This is a field of transplantation that must continue to be supported. Our research, our clinical care, our education,” he said. “For this field to be thwarted by the inability for insurance to pay for this or other agencies to accept it – for specific patients – that would be really a crime.”
CNN article – ‘Whole again’: Man receives double hand transplant after nearly 17 years (Open access)
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