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The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said, declaring the ground-breaking operation a success after 18 months.

The report in The Lancet Child & Adolescent Health provides the first official medical update on 10-year old Zion Harvey, who underwent surgery to replace both hands in July 2015.

“Eighteen months after the surgery, the child is more independent and able to complete day-to-day activities,” said Sandra Amaral, a doctor at Children’s Hospital of Philadelphia, where the operation took place.

“He continues to improve as he undergoes daily therapy to increase his hand function, and psychosocial support to help deal with the ongoing demands of his surgery.”

Harvey had his hands and feet amputated at the age of two, following a sepsis infection. He also had a kidney transplant.

Harvey was already receiving drugs to suppress any immune reaction to his kidney, which was a key factor in his selection for the 10-plus hour hand transplant surgery.

Immunosuppressive drugs must be taken continuously to prevent a patient’s body from rejecting the transplant. These drugs carry risks, including diabetes, cancer, and infections.

Doctors reviewed both the successes and challenges Harvey and his family have faced, noting that a large team of specialists was hard at work supporting them through all the ups and downs.

The child has “undergone eight rejections of the hands, including serious episodes during the fourth and seventh months of his transplant,” said the report.

“All of these were reversed with immunosuppression drugs without impacting the function of the child’s hands.”

Harvey continues to take four immunosuppression drugs and a steroid.

“While functional outcomes are positive and the boy is benefitting from his transplant, this surgery has been very demanding for this child and his family,” said Amaral.

Before the double hand transplant, Harvey had “limited ability to dress, feed and wash himself through adapted processes, using his residual limbs or specialist equipment,” said the report.

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