Penn completes rare double hand transplant for Swiss man

Luka Krizanac marveled earlier this year, when he stuck his hands under a sink faucet: The water was too cold, his body felt the icy jolt, and he instinctively pulled his hands back out.

It had been 16 years since he felt such sensations. His arms and legs were amputated when he was 12 to save him from a life-threatening infection.

Last fall, the 29-year-old came to the Hospital of the University of Pennsylvania from his home in Switzerland for a rare double hand transplant surgery. He hoped it could restore his ability to write, pour coffee, or feel the squeeze of his mother’s hand in his own.

Recoiling from icy water was a milestone in his recovery journey: “It was a reflex, and that was just such a joyful moment,” he said.

Krizanac is only the fifth person to receive such surgery at Penn, and one of about 50 in the world. Some 100 people have had at least one hand transplant since the first was completed in 1999.

Hand transplants require surgeons to reconnect nerves, giving back patients’ ability to feel sensation in the fingers and palm. With extensive physical therapy, people with transplanted hands can move more naturally and precisely than is possible with prosthetic hands.

The complex procedure is still considered experimental and costs hundreds of thousands of dollars that’s rarely covered by private insurance. These transplants remain largely inaccessible to most potential patients.

Penn doctors pointed to Krizanac’s case as an example of how dramatically the surgery can improve a patient’s life. Just one month after receiving new hands, Krizanac was able to lift a tea bag out of his cup. Three months later, he could pick up a hazelnut between his thumb and forefinger.

“This is life-altering surgery, compared to lifesaving surgery,” said L. Scott Levin, Krizanac’s lead surgeon and the cofounder of the Penn Orthoplastic Limb Salvage Center. “To restore the patient’s dignity — that’s the goal of the surgery.”

Penn doctors began to evaluate Krizanac for a transplant in 2018.

The process takes about two years. Patients are educated about risks that include death, undergo a psychiatric evaluation, and are assessed for their ability to cope with an intense recovery.

Krizanac understood the risks, and viewed the surgery as a way to “feel whole again,” he said.

The prosthetic hands that Krizanac has used since 2008 helped him to graduate high school, attend college, and begin a job with a global bank.

But he was still unable to complete basic self-care, hygiene, and work tasks on his own, such as scratching an itch on his face or taking notes at his office.

Despite ongoing technological advances, Krizanac’s prosthetic hands were heavy and felt unnatural. The silicone and rubber covering the mechanical hand and part of his arm was uncomfortably hot, he said.

“I think people don’t realize how much they rely on their hands,” Krizanac said in a video interview with Penn shortly after his surgery. “You’re also isolated in some ways because you can’t participate in as many things.”

Before any organ transplant, patients must be in good health to give them the best chance at recovery without an infection or their body rejecting the new organ.

They must also find a good match with a donor for blood type and immune system markers. For a transplant involving extremities like the hand, doctors also consider the donor’s age, skin tone, and hand size.

Krizanac had been on the waitlist for eight weeks when Gift of Life, the nonprofit that organizes organ donation in the region, called last fall in the middle of the night to say they had identified a deceased donor match for Krizanac. Penn declined to say exactly when the procedure was done to protect the identity of the donor.

The 10-hour surgery involved a team of at least 20 doctors from specialties including plastic surgery, orthopedic, transplant, anesthesia, and nursing. Two teams focused on Krizanac, while two other teams cared for the deceased donor.

Surgeons had spent years preparing for the surgery, with hours-long training sessions to practice each step of the procedure.

The procedure entails connecting nerves, blood vessels, veins, bone, and skin along the forearm. Precision is key for ensuring the donor hand’s nerves can become part of the patient’s nervous system as they heal.

Krizanac still faces an extensive recovery. He will need several hours of physical therapy a week for the next few years as he learns to use his hands.

But doctors are pleased with his progress. Just weeks after the procedure, Krizanac showed signs that the nerve connections had been successful. He lifted a tea bag from his cup after a month, and two months later completed an exercise using his fingers to move foam packing peanuts across the table.

He’s now able to type on his mobile phone and pick up food. When his glasses slide down, he can push them up the bridge of his nose on his own.

“Still every day I wake up and look at them and think, ‘This is not possible. This is a miracle,’” he said.