Transplantation

Transplantation

  

• McCabe
  S, Rodocker G, Julliard K, et al [Univ of
  Louisville, Ky]
  
  Using Decision Analysis to Aid in the
  Introduction of Upper Extremity Transplantation
  
  Transplant
  Proc 30: 2783-2786, 1998
  
  
       
  
  The
  surgical technique for limb transplantation is
  similar to that of replantation.
  Transplantation has been successfully
  performed in a primate model, but has not been
  attempted in humans.
  The authors have evolved a method to help
  clarify the decision process of such transplantation
  and its sequelae, to create utilities for the
  various health states
  and to perform a sensitivity analysis to clarify the
  direction of future research.
  
   
  
  Methods – A
  simple model was created to show the decision
  process. One branch demonstrated negative
  postoperative sequelae and included poor health as a
  summary state. Literature
  was reviewed and experienced health care workers
  were consulted to determine the best estimates of
  the probabilities of events occurring.
  Numeric values were attached to each health
  state, using a time trade-off technique. 22
  surrogate patients were asked whether they would
  choose to remain in a defined state of poor health
  or trade future years of life for improved heath.
  Willingness to trade relates to the value the
  patient places on the state of health being
  considered. Sensitivity
  analyses were performed.
  
   
  
  The
  value of successful transplant was ranked higher
  than the value of amputation, which in turn ranked
  higher than failed transplantation.
  Successful transplantation with poor health
  was preferred to no transplantation. Removal of the
  limb after failed transplantation may be acceptable
  if the patient is in poor health caused by
  immunosuppressives.
  
        

• Dubernard
  J-M, Owen E, Herzberg G, et al [ Hopital Edouard
  Herriot, Lyon, France; Microsearch Found of
  Australia and Outer Sydney Hand and Micro-Surgery
  Unit; St Mary’s Hosp, London; et al]
  
  Human
  Hand Allograft Report on First 6 Months
  
  Lancet 353:1315-1320, 1999
  
      
  
  The
  technique has been described. There were no surgical
  complications. At 8 weeks there was a rejection
  episode which was treated successfully. Passive
  mobilization was started on day one and continued
  till week six. At 100 days, no stiffness was noted,
  but sensation was lacking. There was good callus
  formation at 3 months and advanced healing at 6
  months. At 80
  days, the patient had some sensation.
  
     
  
  They
  conclude that hand transplants can be successfully
  done but sensation and functional analysis are not
  complete.