For the first time, doctors have performed a double hand transplant on a scleroderma patient.
Steven Gallagher is the first scleroderma patient to receive a double hand transplant. The 48-year-old roof tiler from Dreghorn in North Ayrshire had completely lost the functioning of his hands. According to an interview with BBC, 13 years ago Steven developed a rash on his cheeks and nose. The butterfly rash, characteristic of systemic lupus erythematosus (SLE), was also accompanied by pain in his right arm. Doctors initially suspected lupus or carpal tunnel syndrome. However, soon the skin on his hands began to harden, causing pain in both his hands. Thus, causing doctors to diagnose him with scleroderma.
Approximately eight years ago, the pain in Steven’s hand got to an extremely debilitating level. He was unable to uncurl his finger, leaving his in a permanent fist position. This significantly limited his functioning and he had to eventually leave his job.
My hands started to close, it got to the point where it was basically two fists, my hands were unusable. I couldn’t do a thing apart from lift things with two hands. I could not grab anything, it was a struggle to get dressed and things like that.
Steven Gallagher
Steven’s doctors referred him to Professor Andrew Hart, a consultant hand and plastic surgeon based in Glasgow. Professor Hart was the first to suggest a double hand transplant. They also talked with Professor Simon Kay, a consultant plastic surgeon at Leeds Teaching Hospitals NHS Trust. Professor Kay led UK’s first double hand transplant in 2016.
Although Steven initially dismissed the idea of a double hand transplant, he eventually came around to it. Prior to the operation, Steven spent two years preparing for the procedure. This involved psychological evaluation, counselling sessions, and immunological mapping to identify a good donor match. Eventually, in December 2021, Steven underwent the 15-hour procedure.
What is Scleroderma?
Also called systemic sclerosis, the rare autoimmune disorder is characterized by scarring of the skin. Along with the hardening and tightening of the skin, people also face problems with their blood vessels, digestive organs, and other internal organs. Although the exact cause is unclear, experts state that the disease develops from an overproduction and accumulation of collagen in the body. A combination of genetic, immunological, and environmental factors brings about the condition.
Skin-related signs and symptoms are the most common in scleroderma. The face, hands, fingers, and feet are the first to be affected. However, the thickening of skin can also affect the arms, abdomen, chest, and lower body. Other symptoms of scleroderma include Raynaud’s phenomenon, and gastrointestinal symptoms such as heartburn, difficulty swallowing, faecal incontinence, diarrhoea, and constipation. In some cases, scarring of lung tissues that causes shortness of breath, and pulmonary hypertension can also develop.
There is currently no cure for skin tightening and fibrosis, and current treatments focus on preventing complications. Therefore, patients like Steven often experience limited functioning and extreme disability.
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.
Professor Del Galdo, University of Leeds
This is the first time that doctors have conducted a double hand transplant for a scleroderma patient to improve his symptoms. Within a few days of the procedure, Steven could move his fingers – a feat that was impossible pre-surgery.
Double Hand Transplant Allows Man to Pet Dog
In an interview with BBC, Steven reported that prior to the surgery he could not grab things, or even get dressed. It took a team of 30 medical professionals and a 15-hour procedure to transplant the donor’s hands. Following the procedure, Steven spent four weeks in Leeds General Infirmary. He has since been undergoing regular hospital visits for physiotherapy and monitoring.
After the operation I woke up and it was quite surreal because before it I had my hands and then when I woke up from the operation I still had hands so in my head I never really lost any hands. These hands are amazing, everything has happened so quickly. From the moment I woke up from the operation I could move them.
Steven Gallagher
For the first time in years, Steven can now pet his dog and turn on the tap to fill a glass of water. He has also noted a relief in the ‘horrendous’ pain he experienced before the operation. Although he still has trouble doing tasks like buttoning his shirt, experts are convinced that regular physio appointment scans help him relearn to use his hands.
This is not the first time that surgeons have completed a double hand transplant. Last year, a team of doctors at NYU Langone Health conducted a face and double hand transplant on a burns patient.
