The University of Pittsburgh Medical Center has become the second facility in the United States to transplant a hand and is about to complete a ground-breaking follow-up step designed to reduce the use of multiple immunosuppressive drugs and their damaging side effects.

A UPMC surgical team headed by Dr. W.P. Andrew Lee, chief of the division of plastic surgery, transplanted the donor hand to a patient who was identified only as a former Marine who was injured in a training accident. The surgery started March 14 and continued into the next day. By Friday, the UPMC patient, the sixth U.S. hand transplant recipient, "had some movement in his fingers" of his new hand, a UPMC spokeswoman said.

But there is still work to be done. Sometime within the next few days, the patient will receive an infusion of bone marrow from the hand donor that should reduce the amount of traditional anti-rejection drugs needed. The drugs increase the risk of diabetes, hypertension and other disorders.

The infused bone marrow cells target specific cells that could reject the hand and help acclimate the immune system to the new tissue. Prior to the bone marrow infusion, the transplant patient also received antibodies to help overcome the initial, overwhelming immune response, and he will also be treated with a drug called tacrolimus, first used by Dr. Thomas Starzl more than two decades ago in liver transplants to maintain low-grade immunosuppression.

Together, the three post-transplant steps are to be known as the "Pittsburgh Protocol."

"We think we have the potential of accomplishing composite tissue transplants with fewer medications than have been used previously," Dr. Lee said in an earlier interview. "We think this is very important because these transplants don't save any lives but improve the quality of life."

Until the UPMC surgery, Jewish Hospital Heart and Lung Center of Louisville, Ky., was the only U.S. center to do hand transplants, performing five over the past 10 years. According to statistics Jewish Hospital posted on its Web site in January, a total of 40 hands had been transplanted on 32 patients around the world up until that time.