From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine.
SUNY Downstate College of Medicine, New York, NY.
Ann Plast Surg. 2023 Dec 1;91(6):771-778. doi: 10.1097/SAP.0000000000003659. Epub 2023 Aug 12.
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.
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.
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.
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.
手部移植 (HT) 已成为那些遭受截肢或上肢功能不可挽回丧失的患者的最后治疗手段。然而，由于同种异体移植物管理需要付出相当大的努力，并且存在终身免疫抑制的风险，因此患者的资格是治疗成功的关键。因此，本文的目的是调查全球 HT 中心报告的资格标准。
根据系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，对 HT 文献进行了系统回顾，使用了 PubMed、Cochrane、Ovid/Medline 和 Scopus。在有可用信息的情况下，还包括了项目网站和 clinicaltrials.gov 条目。
共审查了 354 篇文章，其中 101 篇符合纳入标准。此外，还纳入了 10 个面向患者的网站和 11 个临床试验。报告最多的标准与移植后同种异体移植物管理的能力有关，包括随访、保险覆盖、心理稳定性和医疗依从性的历史。其他与免疫抑制影响相关的因素，如活跃的怀孕和患者免疫状态，较少受到关注。
由于该领域的新颖性，资格标准仍在不断发展。虽然某些资格因素存在共识，但其他标准在不同项目之间存在差异，并且很少有因素被认为是绝对禁忌症。随着该领域的普及程度不断提高，我们鼓励制定基于共识的循证资格标准。
