A 28-year-old woman from Paris received a double hand transplant in August at the University of Pennsylvania, becoming the second adult to undergo the complex procedure at Penn and the first international patient to receive two new hands in the United States, the university announced Friday.
Laura Nataf lost both hands and both feet when she was a 19-year-old college student studying hospitality management. The amputations were necessary to save her from a life-threatening bloodstream infection, sepsis. Although artificial limbs helped her function — she completed her bachelor's degree and launched her career — she began investigating the possibility of a transplant two years after losing her limbs.
"I got used to [prostheses] quickly, because that was the only thing that could help me have a normal life again," Nataf said Friday. "But I thought about the pros and cons of a transplant and what it could bring to my life. I think taking the antirejection drugs is not such a big deal. And for my future, I want to have kids. I can't imagine having them without being able to touch them and hold them."
Her reconstructive plastic surgeon, Laurent Lantieri at Georges Pompidou European Hospital at Paris Decartes University, had previously performed seven face transplants, including one combined with a double hand transplant. In January, donor hands became available for Nataf in Paris, but the transplant could not be done because of "complications with the health-care system" there, Lantieri said in a statement.
That's when he and his patient turned to L. Scott Levin, the orthopedic and plastic surgeon who directs Penn's hand transplant program. Levin had met them six years earlier at an international medical conference on reconstructive transplants.
Nataf was listed for transplantation at Penn in May, and three months later received her new hands through the Gift of Life Donor Program, the nonprofit that recovers and distributes organs in the Philadelphia region. Her 8.5-hour surgery involved more than 30 surgeons, nurses, and anesthesiologists.
"Laura represents not only the progress being made in the field of bilateral hand transplantation," Levin said, "but she is living proof of our ability to collaborate with medical centers around the world to improve the quality of life of international patients, as well as those in the United States."
Levin called Nataf an "ideal candidate" because of her overall health, her family support, and her intelligence.
He said "details of the financing are still being worked out" for Nataf's transplant. Even American patients with good health coverage face big financial obstacles. Most insurers consider hand transplants to be elective and experimental, so they do not cover the costs — although they do cover the antirejection drugs.
Penn's other adult bilateral hand patient, Lindsay Ess, was transplanted in 2011. Like Nataf, Ess lost her feet and hands to amputation after she developed sepsis.
Hand and face transplantation remains controversial because, unlike major organ replacements, "composite tissue" transplants — so called because they involve attaching blood vessels, bones, nerves, and soft tissues — are not lifesaving. Yet patients must take immune-suppressing drugs to prevent transplant rejection, just like organ recipients.
Nataf, who said she was discharged from the hospital last week, is now living near Penn with her parents and undergoing physical therapy to regain hand function. She expects to return to France at the end of October, where therapy will continue. Full regeneration of the nerves can take a year or more.
"I feel very grateful that Dr. Lantieri thought about taking me to the U.S. and that he didn't give up on me," she said.