News Releases

News Releases

Nation’s Fourth Hand Transplant Recipient Has Hand Removed

For Immediate Release: 4/21/2009

LOUISVILLE, KY – Dave Robert Armstrong, the fourth person in the U.S. to receive a hand transplant, had his transplanted right hand removed following recently developed complications.

The hand was surgically amputated on April 16 at the Jewish Hospital Hand Care Center by Kleinert Kutz and University of Louisville hand surgeons. Surgeons providing care to Armstrong stated, “We hold Dave in our thoughts and prayers as he goes through this difficult time in his life. Our physicians, nurses and other health care givers at Jewish Hospital, Kleinert Kutz and the University of Louisville are saddened by this turn of events that has required this surgery to take place.”

Armstrong, a 33-year-old Upland, California resident, received his transplant on July 12, 2008, during a 14-hour surgical procedure led by Warren C. Breidenbach, M.D., with Kleinert Kutz & Associates Hand Care Center. The same hand surgeon that transplanted the hand also amputated the hand. A manager at an automotive shop in Riverside, CA, Armstrong originally injured his dominant right hand seven years ago when a gun misfired.

Breidenbach said, “The cause of the loss of the hand at this point is not fully known. We do know that it was either mechanical loss of the circulation possibly through trauma or loss through rejection. Until we thoroughly examine the tissues taken from the hand, we will not have definitive answers.”

The Louisville team of surgeons has performed hand transplants on more patients than any other team in the world. They have performed hand transplants on five patients over the past 10 years. This is the first instance of a hand transplant performed by this team being reversed. “The one-year graft survival in hand transplantation is similar to kidney transplantation, added Kadiyala Ravindra, M.D., assistant professor of surgery at University of Louisville. “Among the 33 hands transplanted in the Western hemisphere so far, the one-year graft survival is 97%. This compares favorably to the 85–90% success seen in renal transplantation.” Ravindra, along with Joseph Buell, M.D., director, Jewish Hospital Transplant Center, manage all the patients’ immunosuppressive (anti-rejection) medications. After surgery, each patient is placed on a combination of immunosuppressive drugs to lower the risks associated with the anti-rejection medication.

“As this field of composite tissue allotransplantation or hand transplant moves forward, there will continue to be successes and failures,” continued Breidenbach. “We are tremendously proud of the success our team has achieved over the past ten years and are confident that we will determine the cause of the problem and will learn from it as well. We admire and need patients like Dave who will step forward knowing the risk, but who are still willing to participate in this endeavor, not only for themselves, but also for the advancement of medicine and for the treatment future patients.” “Our team will review the data and analysis the biopsies taken during the removal procedure,” added Ravindra. “In the world experience of hand transplantation so far, there have been no instances of graft loss seen in patients who have been compliant with immunosuppression,” continued Ravindra. “Dave has been very compliant with his medications. He did not have any significant episodes of rejection. Even in this instance, we did not find any of the established features of rejection, such as swelling of the hand or a rash. We are in the process of performing a detailed analysis and will determine the reasons for the graft loss. This experience will improve our knowledge of hand transplantation and guide us in the management of current and future hand transplant recipients.” “The use of a right hand over the last eight months changed my life,” said Armstrong. “If I were offered to do this again, even knowing that the hand would only last eight months, I would say yes. There is no exchange for the quality of life I have experienced despite the pain and hard work. It is within a few days to the date when I lost my hand the first time. I think God has a plan for me and I look forward to the day when I can receive the gift of a new hand again.”

A partnership of physicians and researchers at Jewish Hospital Hand Care Center, Kleinert Kutz and the University of Louisville developed the pioneering procedure. A hand transplant, unlike a solid organ transplant, involves multiple tissues (skin, muscle, tendon, bone, cartilage, fat, nerves and blood vessels) and is called composite tissue allotransplantation.

Information, photography and broadcast quality video, including current interviews by the patient and physicians, are available on our web sites at and

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Barbara Mackovic
Senior Manager

Jewish Hospital & St. Mary's HealthCare Kleinert Institute Kleinert Kutz Hand Care Center University of Louisville School of Medicine