World's first double arm transplant undertaken in Munich

August 2, 2008 A 54-year-old German farmer who lost both arms in a farming accident six years ago has become the first patient to receive a complete double arm transplant. The patient, whose name has not been released, underwent the operation at the Klinikum rechts der Isar, part of the Technical University of Munich (Technische Universität München), last week; he is said to be recovering well.

The operation lasted 15 hours and was performed by a team of 40 specialists in Plastic Surgery, Hand Surgery, Orthopedics and Anesthesiology, under the direction of the head of the Plastics and Hand Surgery department, Prof. Hans-Günther Machens, Dr. Christoph Höhnke (Head of Transplants, Senior Physician; Plastics and Hand Surgery) and Prof. Edgar Biemer, the former Chief of Plastic Surgery at the Clinic.

In a press statement released by the clinic, it was revealed that the patient had been thoroughly physically checked and had psychological counselling prior to the surgery to ensure he was mentally stable enough to cope with the procedure. Since completion of the surgery, the patient has been on immuno-suppressant drugs to prevent rejection of the new limbs.

Following the surgery, the press release from the clinic's press manager, Dr. Tanja Schmidhofer, included the following statement: The flow of blood was [re-]started in intervals of 20 minutes because the anaesthetists had to make sure that the patient would not suffer from the blood flowing back from the transplanted parts. No significant swelling was seen, nor indeed any ischemia (lack of blood flow to the tissues). This is a testament to the surgeons who established a fully functioning blood flow…the main nerves, the Musculocutaneus, Radial and Ulnar nerves were all attached and sewn together, and finally an external fixator was applied, with pins in the lower and upper arms, avoiding the risk of pressure points and sores. The operation was successfully completed after 15 hours.

Without the immuno-suppressant drugs given to the patient, the risk of there being a Graft-versus-Host Reaction or GvHR, would have been significant due to the upper arm containing a large amount of bone marrow, consisting of ICC's or Immuno-Competent Cells, which would have triggered a near total rejection of the new limbs. A GvHR is a condition which results in the cells from the transplant attacking the immune system of the body.

Indications from the clinic suggest that the double attachment went well, although it could be up to 2 full years before the patient is able to move the arms.

The donor arms came from an unnamed teenager, who is believed to have died in a car accident.