Purpose
We performed a qualitative study to understand the psychosocial factors associated
with success in upper-extremity vascularized composite allotransplantation from the
perspective of transplant providers.
Methods
We recruited 13 providers actively involved in upper-extremity vascularized composite
allotransplantation. Participants included physicians, nurses, social workers, occupational
therapists, and research administrators. We conducted semistructured face-to-face
focus group interviews using a guide that explored providers’ perceptions of qualities
contributing to transplant outcome. Topics included social support networks and their
influence on recovery, barriers to treatment compliance and successful posttransplant
rehabilitation, and the process of setting patients’ expectations. We performed a
thematic analysis that produced a list of themes, subthemes, and proposed hypotheses
explaining how the themes related to the study’s guiding questions.
Results
The analysis identified numerous factors that contribute to transplant success: (1) recipients’ prior
experiences modify their ability to cope and adapt after transplantation, (2) behaviors
and characteristics such as positivity influence candidacy and may be predictive of
successful outcomes, and (3) social support is essential for improved function and
compliance. The provider care team cited difficulty in predicting recipient compliance
and in setting realistic expectations.
Conclusions
Motivated recipients with developed coping and resiliency, a positive attitude, and
stable, physically-able caregivers are perceived by providers to have greater success
after transplantation.
Clinical Relevance
Findings from this work may help providers determine optimal candidates for upper-extremity
vascularized composite allotransplantation.
Key words
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References
- Human hand allograft: report on first 6 months.Lancet. 1999; 353: 1315-1320
- Clinicopathologic features of graft rejection of the first human hand allograft.Transplantation. 2003; 76: 688-693
- The history and evolution of hand transplantation.Hand Clin. 2011; 27 (vii): 405-409
- Bilateral trans-humeral arm transplantation: result at 2 years.Am J Transplant. 2011; 11: 1085-1090
- Experience with patient referrals for upper extremity transplantation at a U.S. academic medical center.J Hand Surg Am. 2017; 42: 751.e1-751.e6
- Psychosocial outcomes after bilateral hand transplantation.Plast Reconstr Surg Glob Open. 2015; 3: e533
- The Chauvet 2014 meeting report: psychiatric and psychosocial evaluation and outcomes of upper extremity grafted patients.Transplantation. 2016; 100: 1453-1459
- An overview of psychosocial assessment procedures in reconstructive hand transplantation.Transpl Int. 2014; 27: 417-427
- The psychological assessment of candidates for reconstructive hand transplantation.Transpl Int. 2012; 25: 573-585
- Perceived success in upper-extremity vascularized composite allotransplantation: a qualitative study.J Hand Surg Am. 2021; 46: 711.e35
- Using thematic analysis in psychology.Qual Res Psychol. 2006; 3: 77-101
- Standardizing psychosocial assessment for vascularized composite allotransplantation.Curr Opin Organ Transplant. 2016; 21: 530-535
- World experience after more than a decade of clinical hand transplantation: update on the Innsbruck program.Hand Clin. 2011; 27 (viii): 423-431
Article info
Publication history
Published online: July 12, 2021
Accepted:
May 5,
2021
Received:
March 13,
2020
Footnotes
This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs under the Reconstructive Transplant Research Programe Qualitative Research Award under Award No. W81XWH-17-1-0400. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
