Friday, April 16, 1999 Published at 10:53 GMT 11:53 UK
Thumbs up for hand transplant
The complex elements involved in the operation
Doctors have hailed the world's first hand transplant as a success.
Six months after the pioneering surgery in Lyon, France, Australian businessman Clint Hallam can feel pressure in the middle of the palm of his transplanted hand.
Mr Hallam's forearm was amputated following a circular saw accident more than 14 years ago.
He received the right forearm and hand of a brain-dead male donor in a three-and-a-half hour operation carried out by an international team of surgeons at the Edouard Herriot Hospital.
Doctors were concerned that the transplanted hand would be rejected by the body's immune system, which is programmed to attack and destroy any foreign invaders.
If transplanted tissue is rejected, it has to be removed.
To minimise the risk of rejection the doctors made sure that the blood and tissue types of the donor and recipient matched as closely as possible.
Mr Hallam was also given immunosuppressive drugs to suppress the immune response.
After the initial success of the operation, Mr Hallam participated in a follow-up programme involving intensive physiotherapy and psychological support.
Writing in the medical journal The Lancet, Professor Dubernard and colleagues said that mild signs of skin rejection were seen eight to nine weeks after surgery.
However, these signs disappeared after the dosage of some of the immunosuppressive drugs was increased.
Professor Dubernard said: "We have confirmed the technical feasibility of limb transplantation. No technical complications were observed."
Intensive physiotherapy enabled Mr Hallam gradually to increase movement in the transplanted limb.
After 100 days, he had feeling in the wrist creases, and after six months he could feel deep pressure in the mid palm.
Mr Hallam will have to take drugs for the rest of his life to prevent rejection.
Although they should ensure that he can keep his new arm, the drugs do make him more susceptible to infections and cancer.
In an accompanying commentary, Dr Guy Foucher, a hand surgeon, discusses the many factors that could influence the chances of long-term success.
He warns that it may not be easy to live with a transplanted hand, which, unlike other common transplants, remains constantly in full view.
He points out that careful selection of patients for this non-vital operation is the key.
"The ideal candidate for a hand transplant is a young individual with multiple limb amputations whose two hands have been recently and sharply amputed at the wrist and whose psychological make-up and sociofamilial background are good," he said.