Hand recipient impresses doctors with his progress Hand recipient impresses doctors with his progress

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Sunday, March 21, 2010

By Mark Roth, Pittsburgh Post-Gazette

Michael Henninger/Post-Gazette

Right-hand transplant recipient Josh Maloney talks about the rehabilitation of his new hand at his home in Brentwood on Thursday.

"Here's something we couldn't do before," said Josh Maloney, thrusting his right arm out for a handshake.

His grip was quick and firm, which was all the more remarkable, considering that just over a year ago, the hand had belonged to someone else.

Mr. Maloney, 25, lost his right hand in an explosion during a Marine training exercise in 2007. A year ago last Sunday, he became the first person at UPMC to receive a hand transplant.

Since that time, his doctors say, his progress has been remarkable. Much of his function and feeling in the transplanted hand have returned, as he demonstrated during an interview Thursday in his apartment in Brentwood.

Sitting on his couch as his 7-week-old Siberian husky puppy, Shadow, raced madly around the room, Mr. Maloney showed how his index and little fingers have almost normal motion, while his middle two fingers are still stiff and tend to move together. He can twist his wrist right and left but cannot bend it up and down very easily.

As Mr. Maloney talked and moved, two things were clear: He was pleased with his progress, but his transplanted hand is not 100 percent normal, and may never be.

The grip strength in his left hand is 120 pounds, he said, but is just 35 to 40 pounds in his transplanted hand. While his sense of touch has returned, he said, it is still a bit indistinct.

"I know that I'm touching material when I touch cloth, but I couldn't tell you whether it was denim or tweed," he said. "It's not numb, it's just not as detailed."

None of this has stopped Mr. Maloney from performing all kinds of tasks with both hands. He drives, plays video games, and replaces light bulbs and wiring. He has even changed tires and worked on the brakes of his truck and his girlfriend's car.

In most of those cases, he said, he uses his transplanted hand to assist the work of his left hand.

That certainly resonates with Matthew Scott, 48, a paramedic trainer in New Jersey who has the world's longest functioning hand transplant.

A firecracker accident in 1985 destroyed Mr. Scott's dominant left hand. He lived with a prosthetic hand for several years before getting America's first hand transplant at Jewish Hospital in Louisville, Ky., in 1999.

Today, he said, he can hold objects and feel the world around him with his transplanted hand but its function has been rated at about 55 percent of that in his right hand.

"As far as sensation," Mr. Scott said, "I can do rough and smooth, cold and hot, sharp and dull, but if I'm not looking at it, I can't tell if I'm holding an apple, an orange or a baseball."

Despite that and his need to take immunosuppressant drugs, Mr. Scott said he wouldn't trade his transplanted hand for a prosthetic.

"More than anything," he said, "the transplant gave me back the ability to have a two-handed world, to hug my sons fully with both hands, and when they do things that are noteworthy, I can clap louder than anyone."

Mr. Maloney, who also tried a prosthetic for awhile, feels the same.

"I look normal. I feel normal, and I can do everything my friends can do and do it better a lot of the time."

He still gets regular medical checkups and goes to therapy twice a week for about 90 minutes per session. But the rest of the time, he lives an independent life, working full time as a maintenance employee at the International Brotherhood of Electrical Workers Local 5 headquarters on the South Side.

In some ways, Mr. Maloney has developed his own therapy regimen -- particularly with his newfound video game habit.

For the past two months, he said, "as soon as I get off work, me and my buddy are both poor, so I go to his house and we play ['Call of Duty: Modern Warfare 2']," a military video game that requires him to use a joystick, trigger and control buttons.

There have now been more than 40 hand and arm transplants around the world, including eight in the United States -- five in Louisville and three in the past year at UPMC Montefiore.

UPMC's chief hand transplant surgeon, W.P. Andrew Lee, said it is normal that both Mr. Maloney and Mr. Scott use their transplanted hands to back up their other hands.

"I'm not surprised at all that the transplant hand will always be the assist hand," Dr. Lee said. "That's what I tell all the candidates for transplant here."

The proper way to think about hand transplants, he said, is not to compare them to fully functional natural hands, but to compare their function to what happens with any other patient who undergoes major hand surgery.

Even when someone severs a single hand tendon and needs to have it surgically repaired, he said, scar tissue often limits movement afterward, and "the nerves never regenerate 100 percent."

What satisfies Dr. Lee most is that Mr. Maloney has been able to stay on a small dose of a single immunosuppressant medication to prevent rejection of his transplanted hand.

Mr. Maloney was the first hand transplant patient to get the so-called Pittsburgh Protocol, which uses treatments to sharply dampen a patient's immune system right after surgery, and then gives him a dose of bone marrow from the donor a couple weeks later to help his body accept the transplanted tissue.

By doing that, doctors hope patients can subsist on a smaller-than-normal dose of Prograf, the standard antirejection drug. So far, that has been true for Mr. Maloney, who is doing well while taking just a third of his initial dose of the drug, Dr. Lee said.

If he could ever regain full function in his right hand, Mr. Maloney said, "I wouldn't hesitate to re-enlist [in the Marines]." He used to joke with fellow soldiers that he'd stay in the Marine Corps "until they kicked me out. The one place I ever felt I truly belonged was with a rifle in my hand with my friends, doing my job."

For now, though, he is concentrating on entering the IBEW's apprenticeship program to become a union electrician.

Both Mr. Maloney and Mr. Scott said the moment they could move their fingers, they felt the hands belonged to them.

After his hand transplant, Mr. Scott said, "it was kind of a replay from 14 years earlier when I had lost my hand. That day, there was just a stump with bandages and Betadine [antiseptic], and this time I woke up and it was bandages and Betadine and there were fingers peeking out. I made the fingers move, and from that time on, I knew it was my hand.

"I know what a gift my donor gave me, but he gave it to me to take care of and it is mine and it will always be mine."

Mark Roth: mroth@post-gazette.com or 412-263-1130.

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First published on March 21, 2010 at 1:01 am

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