Experience With Patient Referrals for Upper Extremity Transplantation at a U.S. Academic Medical Center

Kiwanuka, Harriet; Aycart, Mario A.; Bueno, Ericka M.; Pomahac, Bohdan; Talbot, Simon G.

doi:10.1016/j.jhsa.2017.05.016

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…For instance, should appropriate candidates only be those self-selecting for evaluation by transplant programs, or should a wider net for potential candidates from the general amputee population be cast? Data from Kiwanuka et al 14 suggest that patients are generally poor evaluators of appropriateness. In an initial effort to answer these fundamental questions, we performed a patient-centered investigation regarding attitudes toward upper limb loss and transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…8–10 The upper limb transplantation literature has focused increasingly on the importance of patient selection in optimizing outcomes. 11–13 Comments are made at meetings by transplantation centers of the large numbers of patients screened for possible surgery, but the difficulty involved in finding the “ideal candidate.” 14 Upper limb transplantation teams comprising hand surgeons, solid organ transplant specialists, and psychologists have generated patient evaluation and selection criteria borrowed from their respective fields. In the abstract, the ideal candidate for upper limb transplantation would demonstrate a profound motivation for transplantation, a strong psychological profile to endure the ups and downs of potential rejection, self-discipline to perform the necessary rehabilitation protocol, compliance with medical regimens for taking of immunosuppressives, a supportive psychosocial environment, and the appropriate intelligence to understand the potential risks.…”

Section: Introductionmentioning

confidence: 99%

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Adjustment to amputation and interest in upper limb transplantation

et al. 2019

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Objective: Upper limb transplantation provides a new restorative option for individuals with amputations. As true for most operations, patient selection is critical to optimizing transplantation outcomes. To improve on the patient selection process, we used qualitative methods to better understand the issues regarding upper extremity loss as well as upper limb transplantation from the amputee point of view. Methods: Individuals with upper limb amputations (age range = 24–73 years) discussed their adjustment following amputation and their interest toward transplantation in either a focus group (n = 5) or semi-structured interview (n = 17). Transcripts were coded by theme and summarized. Results: Participants described a year-long process typified by adjustment to a new role as an amputee, both psychosocially and functionally. We found that the extent of adjustment was inversely related to an interest in transplantation. Conclusions: These findings could explain the difficulty in identifying “ideal” candidates for upper extremity transplantation and may have implications for patient selection and counseling. Level of Evidence: Prognostic Study, Level V

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adjustment to amputation and interest in upper limb transplantation

et al. 2019

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“…The field of HT is exceptionally dynamic and scientific advancement will inevitably drive changes in eligibility criteria, one past example is the age of eligibility. Historically, most centers placed strict age Akdeniz University Hospital 15,16 Antalya, Turkey 2021 Amrita Institute of Medical Sciences 17,18 Kochi, India 2017 Boston Children's Hospital 19 Boston, MA 2022 Brigham and Women's Hospital [20][21][22][23][24][25][26][27] Boston, United States 2011-2022 Chang Gung Memorial Hospital [28][29][30][31] Children's Hospital of Philadelphia 5,[32][33][34][35][36] Taipei, Taiwan Philadelphia, PA 2016-2020 2016-2022 Clinica Cavadas [37][38][39][40][41] Valencia, Spain 2009, 2011 Duke University [42][43][44][45][46][47][48][49] Durham, USA 2011, 2018, 2021, 2022 Emory University 50,51 Atlanta, United States 2015 Hacettepe University 52 Ankara, Turkey 2014 Harbin Medical University 53 Harbin, China 2016 Hôpital Edouard Herriot 9,[54][55]…”

Section: Discussionmentioning

confidence: 99%

Vascularized Composite Allotransplantation of the Hand

et al. 2023

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Background Hand transplantation (HT) has emerged as an intervention of last resort for those who endured amputation or irreparable loss of upper extremity function. However, because of the considerable effort required for allograft management and the risks of lifelong immunosuppression, patient eligibility is critical to treatment success. Thus, the objective of this article is to investigate the reported eligibility criteria of HT centers globally. Methods A systematic review of the HT literature was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, using PubMed, Cochrane, Ovid/Medline, and Scopus. Program Web sites and clinicaltrials.gov entries were included where available. Results A total of 354 articles were reviewed, 101 of which met inclusion criteria. Furthermore, 10 patient-facing Web sites and 11 clinical trials were included. The most reported criteria related to the capacity to manage the allograft posttransplantation, including access to follow-up, insurance coverage, psychological stability, and history of medical compliance. Other factors related to the impact of immunosuppression, such as active pregnancy and patient immune status, were less emphasized. Conclusions Because of the novelty of the field, eligibility criteria continue to evolve. While there is consensus on certain eligibility factors, other criteria diverge between programs, and very few factors were considered absolute contraindications. As the popularity of the field continues to grow, we encourage the development of consensus evidence-based eligibility criteria.

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“…Yet, nonmaleficence has persisted as the focus of ethical discussion in UET from 1998 to 2015, highlighting the concerns of immunosuppression, appropriate patient selection, and risk to benefit ratio . To address these issues, given that self‐referred patients are less likely to be appropriate candidates, the patient, referring physician, and transplant team must be in agreement that UET is consistent with the patient’s narrative and expectations to secure the best possible outcome. The future of the field depends on the continual refinement of indications based on reported evidence, honest disclosure to patients for well‐informed consent, and the need to proceed with “cautious optimism” …”

Section: Upper Extremity Transplantationmentioning

confidence: 99%

Innovations in reconstructive microsurgery: Reconstructive transplantation

Kollar

Tasigiorgos

Dorante

et al. 2018

Journal of Surgical Oncology

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In the past 20 years, reconstructive transplantation (RT) has emerged as a viable reconstructive option for carefully selected patients. More than 100 upper extremity and 40 face transplants have been performed worldwide to date. Concomitantly, the portfolio of reconstructive transplantation has been extended by additional procedures such as lower extremities, abdominal wall, neck, uterus, genitourinary, and pediatric transplants. In the present review article, we aim to summarize the current state of knowledge about this exciting field.

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Experience With Patient Referrals for Upper Extremity Transplantation at a U.S. Academic Medical Center

Cited by 8 publications

References 8 publications

Adjustment to amputation and interest in upper limb transplantation

Adjustment to amputation and interest in upper limb transplantation

Vascularized Composite Allotransplantation of the Hand

Innovations in reconstructive microsurgery: Reconstructive transplantation

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