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Adjustment to Amputation and Attitudes Toward Upper Limb
Transplantation: Implications for Patient Selection
Sally E. Jensen, PhD; Zeeshan Butt; Allen W. Heinemann; David Cella; Todd A. Kuiken, MD, PhD; Gregory A. Dumanian

Northwestern University Feinberg School of Medicine, Chicago, IL

Introduction: Upper limb transplantation (ULT) may positively impact patients’ quality of life; however, the critical need for chronic immunosuppression or tolerance induction is also associated with quantity and quality of life-limiting complications. Identifying patient selection factors that may optimize outcomes is priority. To this end, we examined upper limb amputees’ interest in and attitudes toward ULT.

Materials & Methods: Upper limb amputees (N =22, Age range = 24-73 years old) participated in either a focus group (n = 5) or semi-structured interview (n = 17). Participants discussed their adjustment following amputation and perceptions of ULT. Transcribed interviews were coded for emerging themes using a grounded theory approach.

Results: Results from focus groups and individual interviews indicated that amputees’ interest in and openness towards ULT diminished with longer time since amputation. Several amputees suggested a post-amputation waiting period as an eligibility criterion for transplant, given that interest and attitudes toward ULT may change with time and opportunity for adjustment. Satisfaction with functional adjustment represented another key theme: amputees who were less satisfied with their functional adjustment expressed greater interest in ULT. Amputees who described satisfactory functional adjustment expressed minimal interest secondary to potential functional declines post-transplant. Identification as an amputee also emerged as a theme associated with openness towards transplant. Amputees who described acceptance of their new identity post-amputation reported little interest in transplant, citing a lack of perceived need and concern about the potentially difficult nature of adjusting to a new limb and the possibility of re-amputation. Conversely, several amputees who noted difficulty accepting their self-image post-amputation expressed greater openness to transplant to restore their pre-amputation identity.

Conclusions: There remains a need to better understand patient-centered factors that impact suitability for ULT. With greater time since amputation, and possibly the opportunity for improved functional and identity adjustment, amputees may no longer view ULT benefits as outweighing the risks. Indeed, in their process of coming to identify as an amputee, they may be averse to the idea of a transplant, which carries the risk for re-amputation. Based on our interviews with upper limb amputees, we recommend a post-amputation waiting period of at least one year to better assess post-amputation adjustment.

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