title: Functional and Psychosocial Outcomes of Hand Transplantation Compared with Prosthetic Fitting in Below-Elbow Amputees: A Multicenter Cohort Study.
abstract: BACKGROUND
  Hand-transplantation and improvements in the field of prostheses opened new frontiers in restoring hand function in below-elbow amputees. Both concepts aim at restoring reliable hand function, however, the indications, advantages and limitations for each treatment must be carefully considered depending on level and extent of amputation. Here we report our findings of a multi-center cohort study comparing hand function and quality-of-life of people with transplanted versus prosthetic hands.
  
  
  METHODS
  Hand function in amputees with either transplant or prostheses was tested with Action Research Arm Test (ARAT), Southampton Hand Assessment Procedure (SHAP) and the Disabilities of the Arm, Shoulder and Hand measure (DASH). Quality-of-life was compared with the Short-Form 36 (SF-36).
  
  
  RESULTS
  Transplanted patients (n = 5) achieved a mean ARAT score of 40.86 ± 8.07 and an average SHAP score of 75.00 ± 11.06. Prosthetic patients (n = 7) achieved a mean ARAT score of 39.00 ± 3.61 and an average SHAP score of 75.43 ± 10.81. There was no significant difference between transplanted and prosthetic hands in ARAT, SHAP or DASH. While quality-of-life metrics were equivocal for four scales of the SF-36, transplanted patients reported significantly higher scores in "role-physical" (p = 0.006), "vitality" (p = 0.008), "role-emotional" (p = 0.035) and "mental-health" (p = 0.003).
  
  
  CONCLUSIONS
  The indications for hand transplantation or prosthetic fitting in below-elbow amputees require careful consideration. As functional outcomes were not significantly different between groups, patient's best interests and the route of least harm should guide treatment. Due to the immunosuppressive side-effects, the indication for allotransplantation must still be restrictive, the best being bilateral amputees.
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors: Stefan
authors: S
authors: Salminger
authors: Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria.
authors: Agnes
authors: A
authors: Sturma
authors: Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors: Aidan D
authors: AD
authors: Roche
authors: Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria.
authors: Laura A
authors: LA
authors: Hruby
authors: Department of Physical Medicine and Rehabilitation, Danube Hospital Vienna, Vienna, Austria.|Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria.
authors: Tatjana
authors: T
authors: Paternostro-Sluga
authors: Center for Advanced Psychology in Plastic and Transplant Surgery, Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Martin
authors: M
authors: Kumnig
authors: Department of Physical Medicine and Rehabilitation, Medical University of Innsbruck, Innsbruck, Austria.
authors: Marina
authors: M
authors: Ninkovic
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Gerhard
authors: G
authors: Pierer
authors: Departments of General and Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Stefan
authors: S
authors: Schneeberger
authors: Department of Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Markus
authors: M
authors: Gabl
authors: Hand Trauma Center, St. Hedwigs's Hospital, Trzebnica, Subdepartment of Replantation of Limbs, Trzebnica, Poland.
authors: Adam
authors: A
authors: Chelmonski
authors: Hand Trauma Center, St. Hedwigs's Hospital, Trzebnica, Subdepartment of Replantation of Limbs, Trzebnica, Poland.|State Higher Medical Professional School, Opole, Poland.
authors: Jerzy
authors: J
authors: Jablecki
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.|Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
authors: Oskar C
authors: OC
authors: Aszmann
mesh_terms: D000328:Adult; D000674:Amputees / Q000523:psychology*; D001186:Artificial Limbs / Q000523:psychology*; D015331:Cohort Studies; D006225:Hand; D063987:Hand Transplantation / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult