PHILADELPHIA — It’s 3,705 miles from Paris to Philadelphia, and another 730 from Paris to Corsica, France – that’s where Laura Nataf was on vacation when she got the call. In the next 36 hours, Laura would travel more than 4,400 miles to Hospital of the University of Pennsylvania to receive new hands. The 28-year-old Parisian took one police escort and two plane rides to the United States for a bilateral hand transplant.
As the result of a collaborative effort between Penn Medicine, Paris Descartes University, and Gift of Life Donor Program, Laura is the first international patient to receive a double hand transplant in the United States, and is only the second adult to be transplanted at Penn Medicine.
“Laura represents not only the progress being in made in the field of bilateral hand transplantation and the advancements of Penn’s Hand Transplant Program, but she is living proof of our ability to collaborate with medical centers around the world to improve the quality of life of international patients, as well as those is the United States,” said L. Scott Levin, MD, FACS, chair of Orthopaedic Surgery, a professor of Surgery in the division of Plastic Surgery in the Perelman School of Medicine at the University of Pennsylvania, and director of Penn’s Hand Transplant Program. “Our colleagues from Paris Descartes University brought Laura to us a few years ago for initial introduction, and we have been working to prepare for her procedure ever since.”
At 19-years-old, Laura’s hands and feet were amputated as a result of sepsis, a blood infection which can lead to tissue damage, organ failure, and even death. Living without hands, Laura had been using prosthetics to perform daily tasks. Two years after losing her limbs she began asking her care team about hand transplantation, and sought out those who would be able to perform the procedure in her native country.
“I have been caring for Laura for nearly seven years, after she came to me seeking a double hand transplant in 2009,” said Laurent Lantieri, MD, chief of the department of Plastic and Reconstructive Surgery at Hôpital EuropéenGeorges Pompidou at Paris Descartes University, who has previously performed seven face transplants including one combined face and double hand transplant. “We spent the next few years evaluating Laura as a candidate for transplantation, and put a plan in place to prepare and list her for a transplant. In January 2016, with donor hands available, there were complications with our healthcare system and we were unable to complete Laura’s transplant in France.”
This is when Lantieri brought Laura to Penn Medicine to be listed.
“I first met Laura in 2010 at the American Society of Reconstructive Transplantation meeting in Chicago,” said Levin. “She had come to meet with patients from across the world who had received hand and face transplants, and with the doctors who performed them. We had not yet performed our first transplant at Penn, but I was impressed with Laura’s determination; she had her mind set on becoming a bilateral hand transplant recipient. She and I kept in touch through Laurent, and with our first adult bilateral hand transplant a year later, our program was building momentum and would continue to do so.”
Over the past 12 months, the collaborative team worked closely with partners at Gift of Life to list Laura and locate suitable organs for transplantation. She was actively listed for transplantation May 2016 and was transplanted three months later. In August 2016, a team of more than 30 members from three surgical specialties spent eight and a half hours in the operating room for the procedure.
“Over the last five years, and even leading up to our first transplant in 2011, we have been routinely practicing new techniques and honing our skills in Penn’s Human Tissue Lab in an effort the improve, and perfect the procedure,” said Benjamin Chang, MD, associate chief of the division of Plastic Surgery and associate professor of Clinical Surgery in the Perelman School of Medicine at the University of Pennsylvania. “We created a method for developing and improving complex surgical procedures with detailed planning, practicing in the Human Tissue Lab, and incorporating feedback for enhancement from the entire team. We repeated the cycle until we felt confident that we were prepared to do Laura's operation. We were able to complete her surgery in eight and a half hours, which is three hours shorter than our first transplant and two hours shorter than our second.”
Vascularized composite allotransplantation (VCA), specifically bilateral hand transplantation, is a complex procedure that involves surgical and non-surgical components. Following extensive medical screenings and evaluations, the potential recipient can be listed to receive a transplant. Once donor organs become available, they are evaluated by the surgical team and are deemed fit for transplant for the specific recipient.
Surgeons from various specialties including orthopaedic, plastic, and transplant surgery perform different segments of the procedure: connecting the radius and ulna; connecting arteries and veins with delicate microvascular surgical techniques; establishing blood flow through what’s called vascular anastomosis; attaching muscles and tendons; repairing multiple nerves the provide sensibility and motor function; and closing the skin.
“When dealing with hand transplantation, and similar VCA procedures such as face transplants, the requirements of identifying a donor change,” said Richard Hasz, vice president of clinical services for Gift of Life. “For these patients we have to take into account additional criteria such as gender, ethnicity, race, skin color and tone, and size. But what’s constant is the respect for donors and their families, careful selection of the recipient, and commitment to obtaining family authorization. For 42 years, Gift of Life Donor Program has partnered with transplant centers throughout this region to bring innovative transplant procedures to patients in need. Each one of these procedures would not be possible without the generosity of a donor and a donor family. We extend our condolences on their loss and thank them for their selflessness and for their gift that made this surgery possible.”
Following this transplant, the recipient is prescribed daily immunosuppressant medications to prevent their body from rejecting the new limbs, which is then followed-up by rigorous occupational and physical therapy to regain hand function and use. Once she is able, Laura will return to France to continue treatment with Lantieri and his team. She is expected to participate in daily therapy sessions, with the hope that she will see significant improvement in her function within the first twelve months.
“This international collaboration, both in planning and preparation and in the operating room, was possible not only because of the members of the Penn, Paris Descartes University, and Gift of Life teams, but because of the countless others caring for Laura on the ground in France and those who played a critical role in getting her to the United States,” said Levin. “We’re now becoming the epicenter of international limb transplantation and salvage.”
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Since 1974, Gift of Life has served as the link between donors and patients awaiting life-saving transplants in the eastern half of Pennsylvania, southern New Jersey and Delaware. Gift of Life Donor Program is the nation’s most active and well-respected organ procurement organization, coordinating more than 42,000 life-saving organ transplants and approximately 600,000 tissue transplants during the last 42 years. For more information on organ and tissue donation, please call Gift of Life at 1-800-DONORS-1 or visit its website, www.donors1.org.
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