Getting a Grip on Scleroderma: Double Hand Transplant for Scleroderma Patient

Take a look at your own hand. You may be using it to scroll on your computer, or to hold your phone. Take a moment to think about how complex it is, with four fingers, a thumb, knuckles, freckles, fingernails. We haven’t even looked at the wrist which comes with its own detailed internal structure. Now use this context to imagine just how exciting it is that a team of plastic surgeons at the University of Leeds successfully managed to transplant something as complicated as a hand. Isn’t that amazing?

Scleroderma is a systemic autoimmune disease that causes scarring of the skin and internal organs, and in some cases the hands can be badly affected, with fingers completely locked in a fist position. There is currently no cure for fibrosis, meaning that nothing can be done for these patients who experience a high level of disability. One such patient used to be Steven.

Professor Del Galdo, the head of the scleroderma team at the University of Leeds explains how he met Steven, a gentleman with scleroderma whose hands were severely impacted by his condition. “Following a talk (organised by SRUK) in Glasgow, where I mentioned that plastic surgery can sometimes help to increase hand function, [Steven] got in touch with his local hand surgeon to see what could be done. He was then referred to the Leeds team because his hands were too advanced for any restorative surgery.”

Steven’s hands were clenched in a permanent fist due to the fibrosis and muscle contracture of scleroderma, which meant he was unable to grip objects or spread his fingers out. This had significantly impacted his quality of life, leading him to seek a surgical solution.

Thus began a two-year journey of preparation, which included a year of counselling for Steven, to ensure he was certain about the transplant, immunological mapping to make sure any donor hands would be a match, and a false alarm with a potential pair of donor hands. Just before Christmas in 2021, led by Professor Simon Kay, Steven underwent a 15-hour surgery and became the first recipient of a bilateral hand transplant on a person with scleroderma.

Following his surgery, he has been given a new lease of life as he is now able to do so much more with his hands than previously. Within a few days of the surgery, Steven could “already move his fingers and squeeze my hand.” He could “do more than he could” with “his other hands.” Since the surgery he has been working with a rehab team to regain hand function – both to get used to his new hands, and also in light of the fact that his range of motion in his ‘old hands’ was extremely limited due to scleroderma, and he has to relearn how to use them.

Following the surgery, the scleroderma team, led by Professor Del Galdo at the University of Leeds, can initiate some very novel research. They will be examining whether Steven’s transplanted hands, which were previously unaffected by either scleroderma or Raynaud’s, begin to experience symptoms. This will be achieved through self-monitoring from Steven, and through the collection of skin biopsies to monitor biomarkers.

“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”

Hand flexion contractures are common in scleroderma and can affect around 30% of those with the condition. When this happens, it presents challenges for those affected in terms of their ability to self-care along with general well-being. Transplantation may seem drastic, but it offers a new hope in restoring hand function in the most severely affected. SRUK wishes Steven a smooth recovery."