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 Marys 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.