The Chauvet 2014 Meeting Report

Abstract

Under the auspices for the International Society on Hand and Composite Tissue Allotransplantation, a section of The Transplantation Society (IHCTAS), a meeting was convened on March 21-22, 2014 in Paris to review the following areas that were deemed significant in the understanding of the psychosocial evaluation and outcomes of upper extremity transplant recipients: required domains of the evaluation, screening instruments, clinical monitoring pretransplant, clinical monitoring posttransplant, patient and team expectations, body image, psychiatric complications, functional goals and quality of life, ethics and media relations. Experts in the fields of psychiatry and psychology, transplantation, social work, ethics, and transplant administration met and reviewed center experiences and literature. The attendees highlighted the importance and the complexity of the psychiatric assessment in this field of transplantation. Moreover, the necessity to develop common instruments and evaluation protocols to predict psychosocial outcomes as well as to understand whether we are transplanting the right patients and how the transplantation is affecting the patients were pointed out. Psychiatric complications in upper extremity transplanted patients have been reported by the majority of teams. Preexisting psychiatric difficulties, the initial trauma of amputation, or adjusting to the transplantation process itself (especially the medical follow-up and rehabilitation process) appeared to be important factors. Monitoring during the whole follow-up was recommended to detect psychiatric issues and to facilitate and ensure long-term adherence. The participants proposed an annual meeting format to build upon the findings of this inaugural meeting to be called the Chauvet Workgroup meeting.

Psychosocial Predictors of Upper Extremity Transplantation Outcomes: A Review of the International Registry 1998–2016

“…Third, due to the limited statistical power, we cannot draw definitive conclusions nor conduct stratified analysis for certain age groups and sex. Fourth, there is no standardized patient selection method, 2 , 8 , 17 and selection bias prevails in transplant candidacy. Fifth, there is limited global standardization of psychiatric care and psychosocial metric utilization between transplant centers.…”

“…Anecdotal evidence and expert opinion suggestthat psychosocial factors are an important contributor to consistent, predictable, and reliable patient outcomes. 2 …”

“…Much of our current research is centered on surgical technique, transplant survival, immunosuppression, 3 – 5 and rehabilitation protocols, 6 , 7 with limited emphasis placed on the importance of patient selection. 2 , 8 – 11 Often, UET candidacy is based on prior experience with more routine surgical procedures or based on biases from small numbers of transplants. To date, psychosocial factors in UET patients have been poorly published, likely related to the difficulty in gathering data in these areas and their seeming intangibility.…”

Lessons Learned from the Amputation of a Bilateral Hand Grafted Patient due to Psychiatric Disorders

“… 1 Consequently, the approach of the various teams varies, and so far no consensus on the optimal psychosocial evaluation and management of the patients exists. 2 , 3 Herein we report a long-term failure in UET mainly due to psychiatric disorders and the lessons learned from this case.…”

Characteristics and Immunomodulating Functions of Adipose-Derived and Bone Marrow-Derived Mesenchymal Stem Cells Across Defined Human Leukocyte Antigen Barriers

“…Vascularized composite allotransplantation (VCA) is an emerging field, expanding the armamentarium for reconstructive surgery after severe trauma, illness, or other causes of extended tissue loss. Next to the reconstitution of anatomical and psychosocial integrity ( 1 ), VCA allows functional recovery of extremities including fine motor skills, strength, and sensibility ( 2 ). So far, more than 200 VCA transplantations have been performed worldwide, and immunosuppressive strategies improved over time.…”