December 2, 2011
A limited number of hand transplants have been performed around the world. However, transplant recipients have required the conventional "triple immunosuppression" regime with significant potential for adverse effects from life-long heavy immunosuppression. Based upon our laboratory findings, an immune modulatory protocol has been developed using donor bone marrow infusion that reduces required immunosuppression to a single anti-rejection medication (monotherapy). This protocol has been successfully applied to 8 hand/arm transplants in 5 patients by our team with follow-up ranging from 14 to 32 months. Good to excellent functional return has been observed in 4 patients with significant enhanced activities of daily living. Minimizing immunosuppression would greatly broaden the applicability of hand/arm transplantation for optimal functional return and life quality restoration.
W. P. Andrew Lee, MD is the Milton T. Edgerton, MD, Professor and Chair of the Department of Plastic and Reconstructive Surgery at the Johns Hopkins University School of Medicine. A hand surgeon and basic science researcher, he conducts investigations on tolerance strategy for composite tissue allografts, such as hand or face transplants, to ameliorate the need for long-term systemic immunosuppression.
An honors graduate in physics from Harvard College, Dr. Lee received his medical degree from Johns Hopkins University School of Medicine, where he also completed his general surgery residency and microvascular research fellowship. He completed his plastic surgery fellowship at the Massachusetts General Hospital and his orthopedic hand fellowship at the Indiana Hand Center. In 1993 he joined the plastic surgery faculty at Massachusetts General Hospital, Harvard Medical School, and became director of the Plastic Surgery Research Laboratory and subsequently chief of hand service in the Department of Surgery. In 2002 Dr. Lee was recruited to the University of Pittsburgh, where he served as Division Chief of Plastic Surgery until 2010.
Dr. Lee has received more than 70 awards and honors, including the Kappa Delta Award from the American Academy of Orthopaedic Surgeons, and Sumner Koch Award and Sterling Bunnell Traveling Fellowship from the American Society for Surgery of the Hand. He is currently serving as the President-Elect of the American Society for Surgery of the Hand, the Chair-Elect of the American Board of Plastic Surgery, and the President of the Robert H. Ivy Society of Plastic Surgeons. In 2008 he helped to found the American Society for Reconstructive Transplantation.
Dr. Lee has mentored about 60 researchers in over two decades, and has authored 120 original publications in peer-reviewed journals and 36 textbook chapters on hand surgery and composite tissue transplant subjects. He served on the editorial boards of Transplantation and Journal of Surgical Research, and has been an invited speaker or visiting professor in 40 institutions around the world. The book co-edited by him, Transplantation of Composite Tissue Allografts, was published by Springer in 2008.
Dr. Lee established a multi-disciplinary program for hand transplantation at the University of Pittsburgh Medical Center using an immuno-modulatory protocol based partly upon findings in his laboratory. He led the surgical team that performed the first bilateral hand transplant (2009) and the first above-elbow transplant (2010) in the U.S. The five transplant recipients to date have been maintained on a single immunosuppressant agent (monotherapy), thus minimizing the long-term risks of hand transplantation.