Recipient of hands making progress
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Jeff Kepner, the nation's first bilateral hand transplant recipient, and his wife, Valarie, hold hands shortly after a news conference yesterday at Montefiore Hospital.
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With deadpan humor, Jeff Kepner, the nation's first double hand transplant recipient, said that when he was wheeled to the news conference table yesterday, his first thought was: "Where's my water?"
He was joking about the glasses of water sitting in front of his wife and all the doctors flanking him at UPMC Montefiore Hospital, and the obvious fact that 10 weeks after his historic surgery, he is not quite ready to lift a goblet and drain it.
But he can clench his new hands slightly, and he was happy to demonstrate how he could use that motion to stack plastic cones on top of each other or drop checkers into a game of Connect Four.
It showed that the first part of the transplant to function, as doctors had expected, is the tendons and large muscles connecting Mr. Kepner's forearms to the hands donated in May by the family of a 23-year-old DuBois, Pa., man.
But Mr. Kepner, 57, a former fast-pitch softball star for the U.S. Air Force who lives in Augusta, Ga., does not yet have feeling in the hands and cannot move the fingers individually. That will take until next year, because the nerves from his arms need to grow into the nerve sheaths of his transplanted hands, and that occurs at the pace of about one inch per month, said lead transplant surgeon Dr. W.P. Andrew Lee.
When his new hands become fully sensate, Mr. Kepner said he already knows the first thing he wants to do with them: "I want to hold my wife's hand and my daughter's hand."
While Mr. Kepner's progress has been slow, his doctors are more than pleased with it and say he is right on schedule. They also are happy because he has not suffered a single episode of rejection of his new tissue, despite receiving much lower doses of anti-rejection medication than normal. They attribute that largely to a new treatment approach they call the Pittsburgh Protocol.
Organ transplant patients often take at least three anti-rejection medications to keep their bodies from rejecting the donor's tissue. But under the protocol, UPMC physicians first gave Mr. Kepner a dose of antibodies that suppressed his immune system, and then gave him an infusion of bone marrow from the donor that was designed to coax his body into accepting the new tissue as his own.
As a result, he has been taking only one anti-rejection medication, Tacrolimus, twice a day, said Dr. Gerald Brandacher, an immunology specialist, and doctors hope to ratchet that down to a dose every other day by sometime next year.
Mr. Kepner lost both hands and feet 10 years ago after a severe blood infection destroyed circulation to his extremities, and since then has relied on hook-like prosthetics for his hands and titanium-rod prosthetics for his legs.
Having learned how to function with those devices, he said, his first reaction when his wife Valarie told him about a possible hand transplant was, "There's no way I'd do that."
But doctors in Pittsburgh talked to him and "set my mind at ease" about the procedure. They decided his positive attitude and the fact he had continued to exercise the arm muscles controlling his hands during the time he was an amputee made him a good candidate for the procedure.
He received his new hands in a nine-hour operation May 4 that involved four teams of surgeons -- two for each donor hand and two for each of Mr. Kepner's arms.
Now, after more than two months in the hospital, he is eager to regain the ability to walk so he can go home to Georgia.
He has moved from being a reluctant candidate for a transplant to a person who sees how he might be an inspiration to others.
"I know if I were still sitting at home now and someone else were doing this press conference," he said, "it would make me more interested in getting a transplant."
First Published July 17, 2009 12:00 am
