Triumph, Then Failure in First Four-Limb Transplant

Feb 27, 2012 2:18pm

A 27-year-old Sevket Cavdar was almost the first person  in the world to undergo a successful transplant of two arms and two legs at Hacettepe University Hospital in Ankara, Turkey,  on Friday.

But hopes were dashed  Monday when doctors had to amputate all four of the transplanted limbs because of  “metabolic complications,” according to a statement from the hospital.

The hospital said Cavdar was currently in the hospital’s intensive care unit  but offered no further details about his condition, according to a report from Agence France-Presse.

Cavdar lost all four of his limbs in 1998 after he was accidentally electrocuted.

The hospital announced on Saturday that the 20-hour operation by a team of 52 doctors had succeeded, and Dr. Murat Tuncer, the lead surgeon, called for blood donations to avoid possible complications after the surgery. Then doctors had to remove one leg when Cavdar’s heart and vascular system failed to sustain it. The amputation of the other limbs followed shortly after.

Dr. L. Scott Levin, president of the American Society of Reconstructive Transplantation, told ABC News that it’s likely that Cavdar went into shock after the attached limbs were deprived of adequate blood supply and began releasing metabolites in his body that damaged his circulation.

“In these cases, it’s life before limb. You have to amputate the limbs to save the patient’s life,” said Levin, who was not involved in the Turkish operation.

Levin explained that  limb transplantation was an exceedingly complicated process that required precise coordination, careful rehearsals and contingency plans for things that could go wrong. When he and a team at the Hospital of the University of Pennsylvania performed a transplant of two hands in 2011, it took almost 20 doctors and two years of planning to ensure the success of the operation.

Limb transplantations are not only difficult for doctors to plan but extremely taxing for patients. Levin said the attempt to give Cavdar four new limbs was particularly bold.

“In these transplants, there may be a threshold that we cross in terms of how much of a burden we put on a patient when we try to do more than one limb at a time,” Levin said. “Perhaps the limit  is two extremities and perhaps not more.”

Two months ago at a hospital in the southern Turkish city of Antalya, doctors tried and failed to transplant three limbs – two arms and a leg, the Washington Post reported. The leg had to be removed because of tissue incompatibility.

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