The youngest recipient of a dual hand transplant may be through his surgery, but the real test of the transplant’s success may come as he starts to recover and gain use of his new hands.
Doctors are hopeful that the new hands for Zion Harvey, 8, will hold up during his lifetime, but they also acknowledged that he is in uncharted territory.
Zion lost his hands and feet from a dangerous infection at age 2 and has largely coped with the disability through prosthetics for his feet, but his doctors at the Children’s Hospital of Philadelphia wanted to give him a more permanent solution.
“We wanted to really make sure that this was going to work for our patient and work for a lifetime, not just a year,” Dr. Benjamin Chang, co-director of the Hand Transplantation Program at the Children’s Hospital of Philadelphia said in a video released by the hospital.
After the 10-hour surgery earlier this month, Zion has months of recovery ahead of him, but he’s already reached the record books. Before Zion's groundbreaking surgery, hand transplants had been performed only on adult patients. Chang said because the procedure is so new, they do not know whether Zion's new hands will last forever.
"We just don’t know," Chang said of the transplant's durability. "The adults that have had transplants have had a least one rejection episode after the transplant."
Dr. W. P. Andrew Lee, chairman of the Department of Plastic and Reconstructive Surgery at Johns Hopkins University, said the first successful hand transplant occurred in 1999.
“We think it can go indefinitely, but I have to tell you the longest hand transplant was performed just 16 yeas ago,” said Lee, who was not involved with Zion's surgery. “That’s the track record.”
Other issues the boy might face include the immune system rejecting the tissue or possibly other long-term health consequences of being on immuno-suppressing drugs, Lee said. Zion was already on immuno-suppressants because he had a kidney transplant when he was younger, hospital officials noted.
“In the case of hand transplant, the problem will manifest as rejection of the transplant hand,” Lee explained of possible complications. “If the rejection is mild it can be treated with medication. If it is severe or if it happens repeatedly then it becomes more and more difficult to treat.”
As patients go through physical therapy, they can regain a significant portion of their dexterity, Lee said.
Chang said the goal is currently to get Zion to simply make a fist and open his hand. He said the therapy is complicated because Zion's hands are completely numb as he recovers.
"We’re waiting for him to regain the ability to feel," explained Chang. "The nerves have to grow back from his own native nerves into the transplanted hands...It will grow about an inch a month. It’s going to be six months before he gains feeling in the hands."
Chang said that the hands were attached in a way so that the bone's "growth plate" was left unharmed.
"The area where we [used] the metal plates to join the bones together, we don’t cross over the growth plate," explained Chang. He said the bones would be expected to grow until Zion was through puberty.
In video released by the hospital, Zion is able to move his new hands in physical therapy and even seems to scratch an itch on his face. According to his Chang, Zion's big goal "is to climb the monkey bars."
But prior to the surgery, the 8-year-old said he knew he would be happy as long as he had his family.
“When I get these hands I will be proud of the hands I get,” he says in a video released by CHOP. “If it gets messed up, I don’t care because I have my family.”