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A debilitating autoimmune disease called scleroderma caused UK resident Steven Gallagher to lose the use of his hands after scarring left them trapped in painful fists, but it wouldn’t be the end of his independence. Thanks to plastics specialists experienced in hand surgery, he was able to receive a double hand transplant which has meant that not only is he now pain-free, but he can stroke his dog again.
Thirteen years ago, Gallagher developed coloration on his nose and cheeks which looked similar to a malar – or butterfly – rash associated with the autoimmune condition lupus, reports BBC News. However, as he began experiencing pain in both arms it became apparent that he instead had scleroderma, a condition that’s caused by a person’s body effectively attacking itself.
In systemic sclerosis, another name given to this group of diseases, the immune system hones in on connective tissue attacking things like the skin, blood vessels and internal organs. As a result, people with scleroderma can develop hard, thickened areas of skin that can limit movement and cause pain.
The hands were particularly badly affected in Gallagher’s case, and around seven years ago they began developing hardened skin which caused the fingers to curl into a fist position. It left him in horrendous pain and unable to use his hands, but Professor Andrew Hart of the Canniesburn Plastic Surgery Unit in Glasgow suggested that a double hand transplant could provide some relief.
Hand transplants have been performed before and across the globe, including one case in India which left doctors baffled as the donor hands adopted the same skin tone as the recipient after transplantation. The world's first double hand transplant was carried out in 2015, while the first in the UK was led by consultant plastic surgeon Professor Simon Kay of Leeds Teaching Hospitals in 2016, who also worked with Hart on Gallagher’s case.
Thanks to a team of 30 medical professionals, Gallagher’s hands were successfully replaced with those from a cadaver in a 12-hour operation in December 2021. Incredibly, shortly after waking from the operation he was able to use the transplanted extremities and later realized that his chronic pain was gone.
"He has already seen life changing benefits, for both him and his family, and yet we know there is more to come as his function improves with more time and rehabilitation," said Hart to IFLScience.
"No-one with systemic sclerosis has ever gone through the same procedure before, so we will be monitoring Steven during his continued recovery. However, many of the treatments for systemic sclerosis are based on immune suppression, which he will receive for the rest of his life to protect his transplanted hands."
The remarkable operation is thought to be the first time a scleroderma patient has been given a double hand transplant to manage the condition’s symptoms – and so far, for Gallagher, it appears to have been a life-changing experience. While not yet back to his pre-scleroderma-diagnosis dexterity, he has regained some of his independence and remains hopeful to be able to return to work one day as he continues to recover from the procedure.
Gallagher represents a world-first in that he proceeded to bilateral hand transplantation despite having both his hands, but the rare procedure was one Hart and colleagues felt confident about, as part of what he describes as the largest and best-run publicly funded hand transplant service in the world.
"The many individuals involved, from the highly committed nursing staff and hand therapists, through to the NHS transplantation service and specialist nurses for organ donation who have the delicate but vital role of approaching donor’s families deserve the greatest credit for the service’s success," said Hart. "The donor’s and their families are the heroes in all this, along with the transplant service who enable these decisions to be reached in a sensitive and supportive manner."
