Long‐term outcome after hand and forearm transplantation – a retrospective study

Hautz, Theresa; Messner, Franka; Weißenbacher, Annemarie; Hackl, Hubert; Kumnig, Martin; Ninković, Marina; Berchtold, Valeria; Krapf, Johanna; Zelger, Bettina; Zelger, Bernhard; Wolfram, Dolores; Pierer, Gerhard; Löscher, Wolfgang N.; Zimmermann, Robert; Gabl, M.; Arora, Rohit; Brandacher, Gerald; Margreiter, Raimund; Öfner, Dietmar; Schneeberger, Stefan

doi:10.1111/tri.13752

Cited by 13 publications

(17 citation statements)

References 44 publications

(68 reference statements)

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“…While the option of VCA may provide functional, psychological, social, and even cosmetic benefits for some, there are significant risks associated with lifelong immunosuppression ( Dubernard et al, 1999 ; Hautz et al, 2020 ). Challenges also exist for VCA candidates around financial burden, missed work, and insurance coverage ( Chung et al, 2010 ; Alolabi et al, 2015 , 2017 ).…”

Section: Introductionmentioning

confidence: 99%

“…Understanding the broad spectrum of quality of life issues is critical for being able to weigh the risks and benefits. Patient satisfaction, for example, is one aspect of quality of life that is significantly related to function ( Hautz et al, 2020 ), but other aspects, such as psychosocial function, wellbeing, and meaning making, are less commonly assessed. Bahler (2019) has commented on factors essential to quality of life that are currently not included in most patient assessments: “…our capacity to make meaning, particularly in relation to temporality, embodiment, and intersubjectivity.…”

Section: Introductionmentioning

confidence: 99%

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Education for patients with limb loss or absence: Aging, overuse concerns, and patient treatment knowledge gaps

et al. 2022

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The goals of vascular composite allotransplantation (VCA) for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed. This study aimed to understand patients’ knowledge and perceptions about treatment options for hand loss, including hand transplant. This study will be used to inform a standardized education approach and develop conversation aids for use by clinicians and patients throughout the treatment decision process. Ten individuals who had experienced hand amputation or had congenital limb loss were interviewed to better understand previous and current decisions about treatment, experiences in adjusting to their treatment, and perceptions about hand VCA. From this qualitative interview data, four findings emerged: (1) knowledge and education around VCA as a treatment option; (2) adaptation of individuals with limb loss; (3) fear of risk associated with transplantation; (4) issues of aging and overuse injuries to existing limbs. Results suggests that there is opportunity for expanding education about all treatment options for patients with new loss, long-term loss, and congenital limb loss. Establishing a baseline of knowledge about all options–prosthetics, rehabilitative strategies, and VCA—can help patients evaluate their values and goals of treatment. Issues associated with aging, including overuse and injury, and adaptability over the life course should be included in considerations about treatment choices. Data indicate the need for routinely assessing patient preferences about treatment choice so patients can plan for their future as they adapt and age and as technology for treatments change. To assure that thorough information is provided for current and future decision-making, education about treatment choices and selection procedures for VCA should be standardized.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Education for patients with limb loss or absence: Aging, overuse concerns, and patient treatment knowledge gaps

et al. 2022

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“…For recipients of face and hand transplant, their ability to adhere and develop work-alliance with healthcare providers is known from time of injury [23–25,26 ▪▪ ,27–30]. Also well known is that adherence is paramount to posttransplant rehabilitation and functional as well as psychosocial success [31 ▪▪ ].…”

Section: Adherence and Rehabilitation Are A Life(graft-)-time Commitmentmentioning

confidence: 99%

Vascularized composite allotransplantation: emerging psychosocial issues in hand, face, and uterine transplant

Kumnig

Järvholm

2022

Current Opinion in Organ Transplantation

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Purpose of reviewCurrently, several research approaches warrant further attention, given the influence of psychosocial and bioethical issues on the success of upper extremity (UETx), face (FTx), and uterine transplantation (UTx). This review will highlight recent results of psychosocial and bioethical research in the field of vascularized composite allotransplantation (VCA), discuss most recent findings, provide information to guide future research approaches, and address the importance of a multicenter research approach to develop international standards. Recent findingsPreviously published reports have tried to identify psychosocial factors that are essential to predict psychosocial outcomes and guide posttransplant treatment after VCA procedures. These issues in VCA are receiving more attention but we are still at the beginning of a systematic investigation of these domains. This review article summarizes the emerging psychosocial issues in UeTx, FTx, and UTx by including recent literature and current clinical practice. SummaryEven though different VCA procedures address different domains leading to specific psychosocial issues, common aspects impacting all forms of VCA would benefit of further coordination. These domains include clinical resources, public attitude and perception, bioethical considerations, adherence and rehabilitation, motives for VCA, information needs and multidisciplinary communication, body image, domains of quality of life, coping strategies, and follow-up care.

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“…Rejections frequently occur in VCA recipients, Hautz et al [ 28 ] recorded a total of 43 rejection episodes in five hand and forearm transplantation patients. Out of the 43 episodes, the majority were T-cell mediated rejections, along with 12 antibody-mediated rejections, one B-cell mediated rejection, and one CR.…”

Section: Current Vca Regimens and Limitationsmentioning

confidence: 99%

Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation

et al. 2021

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The field of vascularized composite allografts (VCAs) has undergone significant advancement in recent decades, and VCAs are increasingly common and accepted in the clinical setting, bringing hope of functional recovery to patients with debilitating injuries. A major obstacle facing the widespread application of VCAs is the side effect profile associated with the current immunosuppressive regimen, which can cause a wide array of complications such as infection, malignancy, and even death. Significant concerns remain regarding whether the treatment outweighs the risk. The potential solution to this dilemma would be achieving VCA tolerance, which would allow recipients to receive allografts without significant immunosuppression and its sequelae. Promising tolerance protocols are being studied in kidney transplantation; four major trials have attempted to withdraw immunosuppressive treatment with various successes. The common theme in all four trials is the use of radiation treatment and donor cell transplantation. The knowledge gained from these trials can provide valuable insight into the development of a VCA tolerance protocol. Despite similarities, VCAs present additional barriers compared to kidney allografts regarding tolerance induction. VCA donors are likely to be deceased, which limits the time for significant pre-conditioning. VCA donors are also more likely to be human leukocyte antigen–mismatched, which means that tolerance must be induced across major immunological barriers. This review also explores adjunct therapies studied in large animal models that could be the missing element in establishing a safe and stable tolerance induction method.

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Long‐term outcome after hand and forearm transplantation – a retrospective study

Cited by 13 publications

References 44 publications

Education for patients with limb loss or absence: Aging, overuse concerns, and patient treatment knowledge gaps

Education for patients with limb loss or absence: Aging, overuse concerns, and patient treatment knowledge gaps

Vascularized composite allotransplantation: emerging psychosocial issues in hand, face, and uterine transplant

Clinical and preclinical tolerance protocols for vascularized composite allograft transplantation

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