When people receive transplanted hands or faces, they need to take strong medicines to prevent their body from rejecting the new tissue. A new study found that these medicines can damage the kidneys over many years. Researchers looked at 10 patients who received these transplants and tracked their kidney health for up to 14 years. About 6 out of 10 patients developed kidney problems, with the biggest damage happening in the first year after surgery. The study also found that common kidney tests give misleading results in transplant patients, so doctors need better ways to check kidney health in these patients.
The Quick Take
- What they studied: How transplanted hands and faces affect kidney function in patients taking anti-rejection medicines over many years
- Who participated: 10 transplant patients (7 received new hands, 3 received new faces) followed for an average of 11 years
- Key finding: Six out of 10 patients developed kidney disease within 8.5 years after their transplant, with the worst kidney damage happening in the first year
- What it means for you: If you’re considering a hand or face transplant, understand that kidney monitoring will be an important part of your long-term care. Talk with your doctor about regular kidney check-ups and whether the benefits of the transplant are worth the kidney risks for your situation.
The Research Details
This was a retrospective study, meaning researchers looked back at medical records of patients who had already received hand or face transplants. They collected information about 10 patients (7 who received new hands and 3 who received new faces) and tracked their kidney function over many years—some for more than 14 years. The researchers measured kidney function using two methods: a direct measurement (like a blood test that shows exactly how well kidneys work) and estimated measurements (calculations based on blood tests that doctors commonly use).
The researchers collected detailed information about each patient’s kidney health before and after their transplant, what anti-rejection medicines they took, and other health factors that might affect their kidneys. They wanted to understand how kidney function changed over time and whether the common kidney tests that doctors use were accurate for transplant patients.
This study is important because hand and face transplants are newer procedures, and doctors don’t have as much long-term information about their side effects compared to other transplants like heart or kidney transplants. Understanding kidney risks helps doctors and patients make informed decisions and plan for better monitoring. The study also revealed that the standard kidney tests doctors use might not be accurate for transplant patients, which could lead to missed kidney problems.
This study has some important limitations to understand: it only included 10 patients from one hospital, which is a small group. The study looked backward at medical records rather than following patients forward in time, which can sometimes miss information. However, the study did use direct kidney measurements (the most accurate method) rather than just estimates, which makes the findings more reliable. The long follow-up period (up to 14 years) is a strength because it shows what happens over many years.
What the Results Show
The most important finding was that 60% of patients (6 out of 10) developed kidney disease within a median of 8.5 years after their transplant. Before the transplant, all patients had healthy kidneys with normal function. However, their kidney function started declining immediately after surgery.
The kidney damage followed a two-stage pattern: In the first year after transplant, kidney function dropped sharply by about one-third (34.4 units on the kidney function scale). After that first year, the kidneys continued to decline, but more slowly. By 10 years after the transplant, the average patient’s kidney function had decreased by 27% overall.
At the end of the study period, patients’ kidney function had dropped from an average of 102.4 units before transplant to much lower levels, with many falling below 60 units—the threshold for kidney disease. This pattern is similar to what happens in other types of organ transplants, where anti-rejection medicines cause gradual kidney damage over time.
The study also discovered an important problem with how doctors currently check kidney function in transplant patients. The standard kidney tests that doctors use (called eGFR equations) gave results that were too high—they made the kidneys sound healthier than they actually were. When researchers compared these standard tests to direct kidney measurements, the standard tests overestimated kidney function by more than 10 units. This means doctors might miss early kidney problems if they only rely on these common tests.
This study’s findings match what researchers have seen in other types of organ transplants (like heart, lung, or liver transplants), where anti-rejection medicines also damage kidneys over time. However, hand and face transplants are different because patients don’t need them to survive—they’re done to improve function and appearance. This makes the kidney risk-benefit decision more personal. The study adds important information because hand and face transplants are newer, and doctors had less data about their long-term kidney effects.
This study has several important limitations: Only 10 patients were studied, which is a small number and makes it harder to apply the findings to all transplant patients. The study only included patients from one hospital, so results might be different in other places. The study looked backward at medical records rather than following patients forward, which could mean some information was missed or recorded differently. The study didn’t have a comparison group of transplant patients who didn’t develop kidney disease, so we can’t identify which factors best predict who will have kidney problems. Finally, the study didn’t examine whether different anti-rejection medicine combinations might cause more or less kidney damage.
The Bottom Line
If you’re considering a hand or face transplant: (1) Have a thorough kidney evaluation before surgery to establish your baseline kidney function. (2) Plan for regular kidney monitoring after your transplant—at least yearly check-ups with direct kidney measurements, not just standard tests. (3) Work with your transplant team to optimize your anti-rejection medicine regimen, as some combinations may be gentler on kidneys. (4) Maintain healthy habits like managing blood pressure, staying hydrated, and avoiding kidney-damaging medications when possible. These recommendations have moderate confidence because they’re based on a small study, but they align with best practices for other organ transplant patients.
This research is most relevant for people considering hand or face transplants, their families, and their doctors. It’s also important for transplant surgeons and kidney specialists who care for these patients. People with existing kidney disease should have extra careful discussions with their doctors about whether a hand or face transplant is right for them. However, this study shouldn’t discourage people from getting these transplants if they truly want them—it just means kidney health needs to be monitored closely as part of the long-term care plan.
Kidney damage can start immediately after transplant, with the biggest changes happening in the first year. However, kidney disease (defined as kidney function below 60) typically develops around 8-9 years after transplant based on this study. This means patients should expect regular kidney monitoring for the rest of their lives after receiving a hand or face transplant.
Want to Apply This Research?
- Track kidney function test results (eGFR or direct kidney measurements) every 6-12 months, recording the date and numerical value. Create a simple chart or graph to visualize trends over time, making it easy to spot if kidney function is declining faster than expected.
- Set reminders for scheduled kidney check-ups and blood tests. Log any symptoms that might indicate kidney problems (unusual fatigue, swelling in legs or face, changes in urination). Record your anti-rejection medicine doses and any side effects, which helps your doctor understand what might be affecting your kidneys.
- Create a long-term kidney health dashboard that tracks: (1) kidney function test results over years, (2) blood pressure readings (high blood pressure harms kidneys), (3) medicine adherence and any changes to your anti-rejection regimen, (4) fluid intake and urination patterns, and (5) any new symptoms. Share this data with your transplant team during regular visits to catch kidney problems early.
This research describes kidney complications that may occur after hand or face transplants. This information is educational and should not replace discussions with your transplant surgeon or nephrologist (kidney specialist). Individual kidney function changes vary greatly between patients. If you’re considering a hand or face transplant or have already received one, work closely with your medical team to monitor your kidney health and discuss the specific risks and benefits for your situation. This study involved only 10 patients, so results may not apply to everyone. Always consult qualified healthcare professionals before making medical decisions.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.