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Unknowns Remain

 
 

Dr. Jaimie Shores, Hand/Arm Transplant Surgeon, talks about what may lie ahead for hand/arm transplantation as a treatment option.

 
 

It is difficult to know for certain what recipients will experience with a hand/arm transplant. There are several reasons for this:

  1. Few studies have been done. As a result, few data are available about hand/arm transplant recipients. Without a lot of data, it is difficult to know the overall success of hand/arm transplantation, and how it affects a recipient’s quality of life. The limited data are due in part to the following:
 
  • The field of hand/arm transplantation is still relatively new.1 The first successful hand/arm transplant was performed in 1999.2
  • As of 2019, about 150 hand/arm transplants have been performed worldwide.3-5
  • Most hand/arm transplant surgeries have been performed in the past 10 years, so long-term effects are still being studied.1
  • Some studies have examined short-term outcomes (up to 3 years). Few studies have looked at the medium (3 to 6 years) or long-term (7+ years) outcomes of hand/arm transplantation.6,7
  • There are few studies about recipients’ personal experiences with hand/arm transplantation.
  1. Few survey tools are available to measure hand/arm transplant outcomes in a standardized way. The tools that transplant centers use to measure hand function vary.8 This makes it hard to compare outcomes across patients and across transplant centers.
  1. So far, researchers have found that each hand/arm transplant recipient’s experience is unique. Each recipient’s experience will vary based on their living circumstances such as emotional, mental, and social support from their loved ones and health care providers, access to treatment facilities and services, insurance coverage, health status, and many other factors.

Although the data are limited, the body of research on hand/arm transplantation is growing. The U.S. Department of Defense has provided support for hand/arm transplant research studies, and many transplant programs are working together on research studies that focus on hand/arm transplant recipients.

 

Click Below for More Videos

Videos of Health Care Professionals

Joe Butkus, UE Transplant Occupational Therapist, talks about factors to consider when making a decision about hand/arm transplantation.

Dr. Jaimie Shores, Hand/Arm Transplant Surgeon, talks about the limited information currently available on long-term outcomes of hand/arm transplants.

Dr. Scott Tintle, Chief of Hand Surgery, discusses the controversial nature of hand/arm transplantation and talks about the benefits and risks.

References

Sources

  1. Dean WK, Talbot SG. Vascularized Composite Allotransplantation at a Crossroad: Adopting Lessons from Technology Innovation to Novel Clinical Applications. Transplantation 2017;101(3):452-456.

  2. Lovasik D, Foust DE, Losee JE, et al. Helping Hands: caring for the upper extremity transplant patient. Critical Care Nursing Clinics 2011;23(3):505-517.

  3. Alolabi N, Augustine H, Thoma A. Hand Transplantation: Current Challenges and Future Prospects. Transplant Research and Risk Management. 2017;9:23-29.

  4. Colakoglu S, Tebockhorst S, Mathes DW. Is Vascularized Composite Allograft Transplantation Experimental or an Accepted Surgical Procedure: Results from a National Survey. J Reconstr Microsurg 2020 May;36(4):276-280.

  5. Mendenhall, S. D., Brown, S., Ben-Amotz, O., et al. Building a Hand and Upper Extremity Transplantation Program: Lessons Learned From the First 20 Years of Vascularized Composite Allotransplantation. Hand (New York, N.Y.) 2020;15(2):224–233. 

  6. Benedict JL, Barth RN. How to Help Patients Considering VCA. AMA Journal of Ethics. 2019; 21(11): 960-967.

  7. Hein R, Ruch D, Klifto C, et al. Hand Transplantation in the United States: A review of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Database. Am J Transplant 2019;00:1–7.

  8. Kubiak CA, Etra JW, Brandacher G, et al. Prosthetic Rehabilitation and Vascularized Composite Allotransplantation Following Upper Limb Loss. Plast Reconstr Surg. 2019;143(6):1688-1701.