Vascularized Composite Allotransplantation of the Hand

Abstract

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.

Advancing vascularized composite allotransplantation: essential factors for upper extremity transplant program development

“…Though no universal selection guidelines have been established, a systemic review analyzing shared criteria between various facial transplant programs determined that common factors include e. g. psychological stability, overall appropriate physical status, and medical adherence ( 25 ). Meanwhile, Laspro et al found that eligibility criteria for hand transplantation were consistently centered around capacity to manage the allograft, including access to follow-up, insurance coverage, psychological stability, history of medical adherence, but noted that factors related to immunosuppression were less emphasized ( 26 ). From a patient perspective, the most important themes regarding UE VCA selection criteria are younger age, good physical health, mental stability, willingness to “put in the work,” presence of specific amputation characteristics, and sufficient social support ( 16 ).…”