Kinsley Sarah E, Song Shuang, Petruzzo Palmina, Sardu Claudia, Losina Elena, Talbot Simon G
Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Mass.
Plast Reconstr Surg Glob Open. 2020 Sep 23;8(9):e3133. doi: 10.1097/GOX.0000000000003133. eCollection 2020 Sep.
Upper extremity transplantation (UET) is becoming increasingly common. This article attempts to collate data from cases contributing to the International Registry on Hand and Composite Tissue Transplantation (IRHCTT), define psychosocial themes perceived as predictors of success using statistical methods, and provide an objective measure for optimization and selection of candidates.
The IRHCTT provided anonymous data on UET recipients. A supplementary psychosocial survey was developed focusing on themes of depression, posttraumatic stress disorder (PTSD), anxiety, interpersonal functioning and dependence, compliance, chronic pain, social support, quality of life, and patient expectations. We determined the risk of transplant loss and psychological factors associated with higher risk of transplant loss.
Sixty-two UET recipients reported to the IRHCTT. Forty-three psychosocial surveys (68%) were received, with 38 (88%) having intact transplants and 5 (12%) being amputated. Among recipients with a diagnosis of anxiety (N = 29, 67%), 5 (17%) reported transplant loss ( = 0.03). Among those with depression (N = 14, 33%), 2 recipients (14%) has transplant loss ( = 0.17); while 4 recipients (22%) with PTSD (N = 18, 42%) had transplant loss ( = 0.01). Of participants active in occupational therapy (N = 28, 65%), 2 (7%) reported transplant loss ( = 0.09). Of recipients with realistic functional expectations (N = 34, 79%), 2 (6%) had transplant loss versus 3 (34%) who were felt to not have realistic expectations (N = 9, 21%, = 0.05). Recipients with strong family support (N = 33, 77%) had a lower risk of transplant loss compared with poor or fair family support (N = 10, 23%), but did not reach statistical significance (6% versus 30%, = 0.14).
Anxiety, depression, PTSD, participation in occupational therapy, expectations for posttransplant function, and family support are associated with postsurgical transplant status.
上肢移植（UET）正变得越来越普遍。本文试图整理来自国际手与复合组织移植登记处（IRHCTT）病例的数据，使用统计方法确定被视为成功预测因素的心理社会主题，并为优化和选择候选者提供客观指标。
IRHCTT提供了上肢移植受者的匿名数据。开展了一项补充性心理社会调查，重点关注抑郁、创伤后应激障碍（PTSD）、焦虑、人际功能与依赖、依从性、慢性疼痛、社会支持、生活质量和患者期望等主题。我们确定了移植失败的风险以及与移植失败高风险相关的心理因素。
62名上肢移植受者向IRHCTT报告情况。收到了43份心理社会调查问卷（68%），其中38份（88%）移植功能完好，5份（12%）被截肢。在诊断为焦虑的受者中（N = 29，67%），5名（17%）报告移植失败（P = 0.03）。在患有抑郁症的受者中（N = 14，33%），2名受者（14%）移植失败（P = 0.17）；而在患有创伤后应激障碍的受者中（N = 18，42%），4名受者（22%）移植失败（P = 0.01）。在积极参与职业治疗的参与者中（N = 28，65%），有2名（7%）报告移植失败（P = 0.09）。在对移植后功能有现实期望的受者中（N = 34，79%），2名（6%）移植失败，而在被认为没有现实期望的受者中（N = 9，21%），有3名（34%）移植失败（P = 0.05）。与家庭支持差或一般的受者相比（N = 10，23%），有强大家庭支持的受者（N = 3
