Warren Breidenbach, MD, performed the nation’s first successful hand transplant. With his recent appointment as chief of reconstructive and plastic surgery, the University of Arizona Department of Surgery now has added composite tissue transplantation to the most comprehensive program that already includes solid organ, bone marrow and cellular transplants.
TUCSON, Ariz. – The University of Arizona Department of Surgery at University Medical Center is now the first public institution in the United States to have active clinical programs in all types of adult and pediatric transplants at one academic medical center.
· Solid organ transplants, which include kidney, liver, pancreas, intestine, heart and lung transplants
· Bone marrow transplants, which treat devastating diseases like leukemia and lymphoma
· Cellular transplants, which use islet cells to treat, or even prevent, insulin-dependent diabetes
· Composite tissue transplants, including hand transplants and face transplants, for patients who have suffered limb loss or extensive facial disfigurement
Warren Breidenbach, MD
, a world leader in composite tissue transplantation who performed the nation’s very first hand transplant while in Kentucky, has joined the UA Department of Surgery as chief of its Division of Reconstructive and Plastic Surgery. With the addition of Dr. Breidenbach, the UA Department of Surgery now has a team of surgical experts to offer patients the widest range of transplants in the United States.
Dr. Breidenbach comes to the UA from the University of Louisville, where he performed more hand transplants than any other surgeon in the world. Dr. Breidenbach will establish an institute for composite tissue allotransplantation and regenerative surgery, including hands, face, legs and feet, the first of its kind in the nation.
Plans are to consolidate all of these transplant programs into an Institute for Transplantation, said Rainer Gruessner, MD, chairman of the UA Department of Surgery. This institute will nurture a clinical and research-oriented environment for developing and defining technologies to maintain and improve – and eventually restore – the function of organs damaged by end-stage disease. This work will include growing artificial organs and providing stem-cell therapy as a bridge to a later transplant. As with the clinical transplant program, the institute will be a collaboration with other UA College of Medicine departments and research programs.
The need for such technologies is growing. According to the United Network for Organ Sharing (UNOS), more than 100,000 candidates in the United States alone are on transplant waiting lists, but only about 25,000 transplants are performed each year. That figure does not take into account candidates who fail to qualify for transplants because of medical or financial reasons; otherwise, the number of transplant candidates on the official waiting list easily could double or triple.
“The annual need for organ-replacement therapies in the United States is expected to continue to increase by about 10 percent a year, even as the shortage of donor organs becomes more dire,” Dr. Gruessner said. “For the general population, improved health care has resulted in an increased lifespan, deepening the gap between the number of donor organs required and the number available. Clearly, devices to assist, restore, or completely substitute for organs will play a large role, providing a bridge to a later transplant in some patients, in others, the opportunity to recover without a transplant.”
“The achievements of our trauma program seen during Jan. 8 tragedy, as well as the growth of our transplant program and the entire Department of Surgery, are testaments to the tremendous potential we have at the University of Arizona to be among the nation’s best providers of surgical care for our patients in Arizona and the nation,” said Dr. Gruessner.
Among the many patients who have benefited from the work of the transplant team at the UA are:
Solid Organ Transplant Recipients
Isaac Pacheco, age 9
(Parent Marisole Perez)
Isaac Pacheco was a typical, healthy 9-year-old boy living in Phoenix until a few weeks ago when his mother noticed that the whites of his eyes were yellow. Within days it became clear that he had developed acute hepatitis and it was destroying his liver. He was immediately transferred from Phoenix Children's hospital to the University Medical Center, where he received intensive care, needing a ventilator to help with breathing.
At serious risk for severe brain damage and death, he was listed at the highest possible level of priority for a liver transplant. Because of the immediacy of Isaac’s situation, potential living donors were screened, but none were deemed suitable. Just in the nick of time, a liver became available from a deceased donor, and UA surgeons successfully transplanted a liver on Mother’s Day with no complications. Within the next eight hours Isaac began waking up and the next day he was taken off the ventilator. Only three weeks ago he was fighting for his life, and now he is well on his way toward making a full recovery.
Adrianna Martinez, age 2 1/2 years
(Parents: Michael and Natasha)
Adrianna Martinez from Chandler, Ariz., was born with a rare congenital malformation that makes it impossible to digest food. She also was born with situs inversus – her abdominal organs were positioned on the wrong side – making her condition even more complex. With total parenteral nutrition (TPN), babies can survive by receiving most or all of their nutrition directly into the blood stream, but for reasons that are not completely clear, TPN also can lead to liver failure.
On Nov. 9, 2009, Adrianna successfully received a three-organ multi-visceral transplant as part of a single surgical procedure at University Medical Center – the first procedure of its kind performed in Arizona and the Southwestern United States. The liver, pancreas and small bowel from a deceased baby donor were transplanted “en bloc” (kept together as a single unit) in the seven-hour operation. She is now a healthy, happy toddler.
Riley Honani, age 8 months
(Parents: Travis and Kristy)
At 3 months old, Riley Honani, who lives in Las Vegas, Nev., underwent surgery for what was thought to be a bowel obstruction, but doctors found he was born with ganglioneuromatosis, a genetic disease that causes intestinal failure. As a result of his condition, Riley required TPN, which resulted in liver failure.
Riley was listed for transplant last December and on March 29 he was the first Native American to receive a four-organ multi-visceral “en bloc” transplant – liver, pancreas, small bowel and colon – in Arizona. Doctors say the first year will be critical; so far he is doing well.
Melissa Vincent, age 37, (recipient) and Sara George, age 33, (donor)
Melissa Vincent, known as “Molly” to her family and friends, lives in Las Vegas, Nev., with her husband and two children. In 2007, she started to feel ill and to experience swelling and pain in her lower extremities. She was diagnosed with IgA nephropathy, an autoimmune disorder that has no clear known cause.
Over the last year, it had become more difficult for Molly to perform her daily activities without the help of her family. Her kidney function was down to 7 percent when she had to have dialysis access placed. Molly received the gift of a kidney from her sister, Sara, and underwent a living-related donor kidney transplant May 12, 2011.
Molly’s sister, Sara George, also lives in Las Vegas, Nev. She has been by her sister’s side over the last four years, especially when Molly unexpectedly was admitted to the hospital due to her disease. When she heard that Molly eventually would need a kidney transplant, she wholeheartedly accepted the opportunity to help her sister. She gave her sister a second chance at a normal life.
Chelsey Cornwall, age 29
Emily Cornwall, 29
Chelsey Cornwell from Reno, Nev., and Emily Cornwall from Scottsdale, Ariz., are identical twins. Both were diagnosed with arrhythmogenic right ventricular dysplasia (ARVD) at 17 years old. At that time, they were training for triathlons and didn't know anything was wrong. What tipped them off was Chelsey’s severe edema. Both had defibrillators placed, but that was a temporary solution. Chelsey was able to finish her first year of school at the University of Nevada - Reno before her heart began to fail. She was admitted to UMC and received a heart on May 23, 2001. Emily then went through the transplant evaluation process as her condition worsened and was transplanted on June 4, 2002.
Chelsey finished college and was hired by a company in Northern California. After eight months, she suffered cardiac arrest twice and was diagnosed with very aggressive form of coronary vasculopathy. She was transported to Tucson and received a second heart transplant April 12, 2007.
Chelsey and Emily both work for the same pacemaker company. They lead very healthy, active lives and do not think of themselves as transplant patients.
Bone Marrow Transplant Recipient
Anaya Burton, age 10
(Parent Desiree Guerra)
Anaya Burton is a 10-year-old-girl from Tucson who was diagnosed with acute lymphoblastic leukemia in April 2008, a month before her seventh birthday. She received chemotherapy and achieved a complete remission, but had a bone marrow relapse almost two years later, in February 2010, while she was still on maintenance therapy.
She underwent more intensive chemotherapy, achieving a second remission. Anaya then received high-dose chemotherapy and total body irradiation, which was followed by an allogeneic bone marrow transplant (BMT) from her brother in June 2010. The first patient to receive a BMT at Diamond Children's, Anaya had no complications and was discharged from the hospital four weeks later. She now is off all medications, is in complete remission, and is doing well one year after her transplant.
Islet Cell Transplant Recipient
Nancy Pitts, age 46
For nine years, Nancy Pitts from Sierra Vista, Ariz., lived with chronic pancreatitis, a condition that causes intractable, debilitating abdominal pain. Even the simplest tasks could not be performed without assistance from family, friends, a wheelchair or a walker. Pitts took extremely high doses of narcotic pain medications just so she could get through the day.
Nancy’s suffering ended by undergoing an autologous islet cell transplant in September 2010 at University Medical Center. Surgeons removed her inflamed pancreas, extracted the islet cells, and infused the cells into her liver so it can produce insulin. Today, Nancy uses less than a third of her previous pain medication and needs almost no insulin. Nancy has been given a chance to live her life independently and enjoy her granddaughter.
Composite Tissue Hand Transplant Recipients
Matthew Scott, age 49
Matthew Scott lost his left hand in 1985 from the blast of an M80 firecracker. Scott, who lives in New Jersey, had to re-learn how to use his dominant hand with a prosthetic device.
On Jan. 24, 1999, Scott became the first person in the United States to undergo a successful hand transplant in Louisville, Ky. By April, Scott was able to throw the ceremonial first pitch at the Philadelphia Phillies opening-day game with his new left hand. By June, he was able to return to work.
Richard P. Edwards Jr., age 56
In 2006, Richard Edwards, a chiropractor from Oklahoma was driving his truck when it was overcome by a brush fire. Unable to escape the burning vehicle he was severely burned on his face, arms, back, and hands leaving both hands non-functionable with very little tissue.
On Aug. 24, 2010, Richard received a double hand transplant, a 17 ½ hour operation under Dr. Breidenbach’s direction in Louisville, Ky. Doctors removed his hands, including muscle and bone, but kept the nerves, slipping them inside his new transplanted hands. It was the first time a hand transplant of this type was ever performed. Edwards continues to make progress beyond his 2010 demonstration of being able to curl his fingers and make a half fist.