title: Risk assessment and management in hand and facial tissue transplantation.
abstract: OBJECTIVE
  Since hand and facial tissue transplantation are new treatments, risk data must be derived from early reports of the few cases done to date combined with extrapolations from other procedures with similar risks. This manuscript summarizes data from both sources including eight separate studies that measure the real and perceived risks associated with hand and facial tissue transplantation.
  
  
  METHODS
  Real Risks: Several large clinical studies describing risk data from kidney transplant recipients (10-years experience) and risk data from 49 human hand transplants in 33 recipients (>10 years experience) were reviewed. Perceived Risks: Over 500 subjects with different life experiences (facially disfigured, amputees, laryngectomees, kidney transplant recipients, transplant and reconstructive surgeons, and controls) were surveyed using a standardized and validated risk assessment instrument.
  
  
  RESULTS
  Real Risks: Contrary to earlier estimates the risks of acute rejection are higher (80-85%) while the risks of chronic rejection (<5%) and other complications are lower than previously reported. Perceived Risks: Despite different life experiences, those questioned would accept similar amounts of risk to receive different types of transplant procedures (hand, foot, face, larynx, and kidney) but all would accept the most risk for a facial tissue transplant. Kidney transplant recipients, who live with the risks of immunosuppression, would accept the most risk while facially disfigured individuals and reconstructive surgeons, who have real-life experience with facial disfigurement, would accept the least.
  
  
  CONCLUSIONS
  These studies contribute to the growing body of risk data necessary for moving hand and face transplantation into mainstream medicine.
authors.affiliation: Experimental Trauma and Orthopedic Surgery, Orthopädische Universitätsklinik Friedrichsheim GmbH, Johann Wolfgang Goethe-University, Marienburgstr. 2, 60528, Frankfurt/Main, Germany. jhb121654@gmail.com.
authors.forename: J H
authors.initials: JH
authors.lastname: Barker
authors.affiliation: Department of Sociology, Anthropology and Social Work, Auburn University, 7030 Haley Center, Auburn, AL, 36849, USA.
authors.forename: F
authors.initials: F
authors.lastname: Allen
authors.affiliation: Department of Communication, University of Louisville, 310 Strickler Hall, Louisville, KY, 40292, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cunningham
authors.affiliation: Department of Physiology and Biophysics, University of Louisville, 500 South Preston St., A building, Room 1115, Louisville, KY, 40292, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Basappa
authors.affiliation: Department of Philosophy, University of Louisville, 309 Bingham Humanities Building, Louisville, KY, 40292, USA.
authors.forename: O
authors.initials: O
authors.lastname: Wiggins
authors.affiliation: Banis Plastic Surgery Center, 901 Dupont Rd Suite 202, Louisville, KY, 40207, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Banis
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 585, Cincinnati, OH, 45267, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Alloway
authors.affiliation: Division of Transplantation, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, ML 585, Cincinnati, OH, 45267, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: Steve
authors.affiliation: Department of Trauma, Hand, and Reconstructive Surgery, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
authors.forename: J M
authors.initials: JM
authors.lastname: Frank
keywords: Composite tissue allotransplantation; Face transplant; Hand transplant; Immunosuppression; Risk versus benefit; Standard gamble
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