"His hands have become mine," says the first hand transplant recipient.

• On January 13, 2000, Denis Chatelier was transplanted with both hands in Lyon. A world first.
• 20 years later, Lyons specialists in this type of transplant have taken stock of these transplants, which are still unusual.
• Transplants whose consequences are sometimes difficult to bear for patients and which are hampered by the lack of donors.

At the time of posing in Lyon this Friday noon in front of the journalists, the four men put their hands in evidence for the photo. Delighted, Denis Chatelier applauds in front of the cameras. A strong gesture for this fifties, the first patient in the world to have been transplanted with both hands on January 13, 2000 in Lyon by an international team led by Professor Jean-Michel Dubernard. Twenty years later, the specialists in charge of transplantation at the Hospices Civils de Lyon (HCL) have brought together four of the seven patients who have benefited from a bilateral transplant from Denis Chatelier. "Subjects" remained under close surveillance since their intervention.

One hundred hand transplants worldwide

"These patients are taken care of like we take care of racehorses," said Aram Azarian, hand surgeon at the Parc clinic. With this formula, the specialist wants to illustrate how these hand transplants, out of the ordinary 20 years ago, are still today. Because if the transplant patients, amputated until the operation, have regained much of the use of their hands, the consequences of a transplant such as this one are not without risks.

According to the results obtained on Lyonnais patients and the hundred people transplanted with one or two hands, since, in the world, "the results are good", underlines Aram Azarian. "They find between 30 and 90% of their mobility, between 45 and 50% of normal strength and can do between 50 and 90% of the gestures that can be done with a normal hand," added the surgeon, delighted to see these patients "freed from their dependence".

By his side, Emmanuel Morelon, doctor in transplant immunology, agrees and completes: “We are still in the experimental phase. We still have difficulties. We don't know how long a graft takes, for example. The hands work well, but the immunosuppressive treatments they have to take for life have more or less important consequences. It's a real test, ”he says. Many of them discharge from the skin, similar to sunburns, but not dangerous, according to specialists.

Two amputated patients after ten years of transplant

More serious, transplant patients developed, long after the intervention, vascular rejection which could go as far as amputation of the transplanted limbs. Of the seven patients operated on and followed at HCL, one man lost his transplant after such rejection, ten years after the transplant. And a patient who could no longer bear the complications asked to have her grafted hands removed ten years after her operation.

Difficulties which do not take away the smile present on the face of Denis Chatelier. “Today, I have a light treatment. I often think of my donor. His hands have become mine, I'm very happy about it, ”confides this man, who had been amputated with both hands following the explosion of a homemade bomb. Burned in the fire in his apartment and then amputated, Albéric, 40, benefited from a hand transplant in 2008. “After the fire, I immediately thought of a transplant. I spoke to surgeons who were absolutely against it. The burns on my body made things even more complicated ", underlines this Lille who explains having found" good autonomy in his life and in his physical integrity ". After seven years of cumulative hospitalization, he has just started a work-study program at Toyota to work in management control and get back on track in the professional world.

Julien, 32, also lives with the hands of another since 2009. This Lyonnais was amputated after the explosion of a home-made bomb. A "bullshit of youth" that he paid very heavily. “I waited for the transplant for five years, says this father who was able to return to work in his original profession, cooking. I am more in management, I cook little. But it still reveals what we can do with these new hands. Today in my daily life, if you don't know that I have been transplanted, you don't see it. ” For him, the weeks following the transplant were complicated but he tolerates anti-rejection treatments well. His only uncertainty? The time that the graft will last. “But we are lucky to have Denis in front of us. I tell myself that following in his footsteps, we leave for 20 years, which leaves me at least still new, "smiles the young man.

Significant lack of donors

So many uncertainties that could be removed over the transplants and research, according to Lyons specialists who estimate that it will take another fifteen years to reach a better balance between the benefits and the risks of such an intervention. “We will find solutions. Medicine is advancing ”, underlines Lionel Badet, transplant surgeon at HCL.

To improve hand transplants and perform arm transplants, as should be the case in Lyon where a patient has been waiting for three and a half years, an obstacle remains. “We lack donors, grafts. For this man who has to have an arm transplant, for example, the waiting time becomes very difficult. I appeal for solidarity and national generosity, ”he adds. Aram Gazarian insists: "It is important the hands, to do things, to communicate, to be. When they are lacking, it is difficult. We become dependent and confined. We must not forget that there is no transplant without a donor ”.

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