Background: Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. Method: We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist. Results: Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function. Conclusions: The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified.
Background: Upper extremity transplantation has been performed to improve quality of life, the benefit which must be traded off for the risk created by life-long immunosuppression. We believe the process of decision analysis is well suited to improve our understanding of these trade-offs. Method: We created a decision tree to include a branch point to illustrate the expected recovery of useful function in the transplant, using the best estimates for utility and probability that exist. Results: Our model revealed that when the probability of achieving a good result, graded as Chen level one or two is greater than 73%, transplantation is preferred over no transplantation. The decision is sensitive to the probability of major complications and the utility of a transplanted limb with minimal function. Conclusions: The results of this analysis show that under some circumstances given a high probability of satisfactory functional recovery, unilateral hand transplantation can be justified.
Keywords:
decision analysis; hand transplantation; quality of life; unilateral; utility
Authors: S McCabe; G Rodocker; K Julliard; W Breidenbach; C Marcel; M V Shirbacheh; J Barker Journal: Transplant Proc Date: 1998-09 Impact factor: 1.066
Authors: Palmina Petruzzo; Marco Lanzetta; Jean-Michel Dubernard; Luis Landin; Pedro Cavadas; Raimund Margreiter; Stephan Schneeberger; Warren Breidenbach; Christina Kaufman; Jerzy Jablecki; Frédéric Schuind; Christian Dumontier Journal: Transplantation Date: 2010-12-27 Impact factor: 4.939
Authors: Charles E Canter; Robert E Shaddy; Daniel Bernstein; Daphne T Hsu; Maryanne R K Chrisant; James K Kirklin; Kirk R Kanter; Robert S D Higgins; Elizabeth D Blume; David N Rosenthal; Mark M Boucek; Karen C Uzark; Alan H Friedman; Allen H Friedman; James K Young Journal: Circulation Date: 2007-01-29 Impact factor: 29.690