346.3: Hand and upper limb transplant – the UK experience.
Notice bibliographique
Résumé
Introduction: Since 2012, hand and upper limb (HAUL) vascularised composite allotransplantation has been available in the United Kingdom on a standard of care basis to select patients with upper limb loss who meet the stringent criteria and commitment for transplantation. Here, we report the functional and immunological outcomes of all patients who have had a HAUL transplant in the UK. Methods: This was a single centre retrospective study of prospectively collected data based at the UK centre for HAUL transplantation. All cases of HAUL transplant since the programme’s inception were included. Primary outcome measures were graft survival, episodes of rejection, episodes of infection, side effects of immunosuppressive medications, complications, and functional outcome measures. Results: The UK Hand Transplant service has performed 17 HAUL transplants in 10 patients; 7 male and 3 female. The mean age at time of transplant was 46.7 ± 11.8 years. Aetiology of limb loss included sepsis, trauma (including blast and high tension electrical injury), and loss of function through disease. The later category included one patient with painful, total loss of hand function due to Systemic Sclerosis. Patient 10 was the world’s first to receive a HAUL transplant from a Donation after Circulatory Death (DCD) donor. The graft survival rate is 17/17. No patients have had chronic rejection. Five patients have generated de novo donor specific antibodies. The median number of acute rejection episodes was 3.5 (IQR 1.0-5.0). Three patients have had fungal infections post-transplant (one had mucormycosis). One patient had a peri-prosthetic fracture, osteomyelitis, and delayed union. Three patients have developed diabetes mellitus, controlled with oral medication. Patients with history of renal replacement (eg during severe sepsis) experience significantly greater renal impairment post-transplant and require careful assessment and management. For patients with at least 4 years follow up, Disabilities of Arm, Shoulder and Hand (DASH) scores improved in 5/6 patients. Canadian Occupational Performance Measure (COPM) scores improved in 6/6 patients. There were no psychological rejections, and all patients were happy to have had the transplant. Conclusion: The UK’s HAUL transplant programme is amongst the most active in the Western Hemisphere. HAUL transplant has thus far proven to be a successful and a viable option for a select group of patients. As the transplant programme has matured, we have refined our processes in every aspect from patient selection and work-up for surgery, to donation, and post-operative care. Novel indications are considered as they present. We continue to develop strategies to manage specific challenges, such as renal function post-transplant in patients that required renal replacement at the time of limb loss.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».