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Abu Dhabi, UAEMonday 17 December 2018

World's first double hand transplant on a child is a 'success'

Zion Harvey, who lost both hands as a toddler, can now swing a baseball bat.

Zion Harvey, the first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said on July 18, 2017, declaring the ground-breaking operation a success after 18 months.  AFP PHOTO / Children's Hospital of Philadelphia
Zion Harvey, the first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said on July 18, 2017, declaring the ground-breaking operation a success after 18 months. AFP PHOTO / Children's Hospital of Philadelphia

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At only eight years old, Zion Harvey earned his place in medical history when he became the first child in the world to have a double hand transplant. The operation, which took 11 hours, was a success and Zion can now feed and dress himself, play his beloved baseball and write.

After monitoring him carefully for 18 months, doctors declared the transplant a success after the ground-breaking surgery in Philadelphia.

The report in the medical journal, The Lancet Child & Adolescent Health provides the first official medical update on Zion - now 10 - who underwent surgery to replace both hands in July 2015.

"Eighteen months after the surgery, the child is more independent and able to complete day-to-day activities," said Dr Sandra Amaral, of the Children's Hospital of Philadelphia, where the operation took place. "He continues to improve as he undergoes daily therapy to increase his hand function, and psychosocial support to help deal with the ongoing demands of his surgery."

Zion, who lives in Baltimore, had his hands and feet amputated at the age of two, after he contracted a life-threatening sepsis infection. He also had a kidney transplant and was already taking medicine to suppress any immune reaction to his kidney, which was a key factor in his selection for the hand transplant surgery.

Before surgery, Zion could not wash, dress or feed himself without help. His mother hoped that one day he might be able to brush his own teeth or cut up his own food, while Zion's dearest wish was to grip a baseball bat and play on a climbing frame.

The donor hands became available in July 2015 from a deceased child. Within days of surgery, Zion was able to move his fingers, using the ligaments from his residual limbs.

"Regrowth of the nerves meant that he could move the transplanted hand muscles and feel touch within around six months, when he also became able to feed himself and grasp a pen to write," said the report.

Eight months after the operation, Zion was using scissors and drawing with crayons and within a year, he could swing a baseball bat with both hands. Last August - 13 months after surgery - he threw the first pitch at a Baltimore Orioles game.

But his body also rejected his new hands eight times and he had two 'serious episodes " in the fourth and seventh months after his transplant, said the Lancet report, which was published on Wednesday. "All of these were reversed with immunosuppression drugs without impacting the function of the child's hands."

Immunosuppressive drugs must be taken continuously to prevent a patient's body from rejecting the transplant. These drugs carry risks, including diabetes, cancer and infections. Zion continues to take four immunosuppression drugs and a steroid, although doctors hope to reduce the dose over time.

Dr Amaral said the surgery had been" very demanding" on Zion and his family. Scans have shown his brain is adapting to the new hands, developing new pathways to control movement and feel sensations. Regular meetings with a psychologist and a social worker were part of the recovery process, aimed at helping him cope with his new hands.

Dr Scott Levin, leader of the surgical team that operated on Zion, praised his young patient.

"I've never seen Zion cry. I've never seen him not want to do his therapy. He's just such a remarkable human being. He has such courage and determination and gives us all inspiration," he said.

The first adult hand transplant was carried out in 1998 and the first double hand transplant followed two years later. Since then more than 100 people worldwide have had a hand or arm transplant. In April 2015,The National reported on Afghan soldier Abdul Rahim, who had a double hand transplant in Kochi in Kerala, south India. However, researchers warn that more study is needed before hand transplants in children become widespread. Hand transplant surgeon Dr Marco Lanzetta, also writing in the same medical journal, said prosthetic limbs had developed so much that they were more likely to be the future for other child patients.

Zion might beg to differ. In an update on his progress last year, the little boy said his hands were "the piece of my life that was missing. Now it's here, my life is complete." And he wanted to write a letter to thank the family of the person whose hands he received.