Psychosocial Predictors in VCA
Abstract
Rationale: Major limb loss is a significant cause of disability, imparting functional, psychological, social, quality of life, emotional, and financial costs. This is especially true in the military setting where body armor has spared lives at the cost of limb injuries and loss. Hand and arm transplantation offer the unique opportunity for amputees to ?replace? a lost limb with the closest alternative available. The past 15 years have seen a surge in the number of people receiving hand and arm transplantations, with more than 100 transplants having been performed worldwide. Our international registry contains 59 patients who received 59 transplants (34 single and 34 bilateral). However, outcomes have been highly variable, with some patients returning to work and others losing their limbs to rejection. We believe that delineation of the factors -- including demographic data, medical, surgical, psychological and social -- that are determinants of outcome will help in the standardized evaluation of transplant patients. Using these data, we will develop a model and validate it to help predict the factors that contribute to outcomes in hand and arm transplantation. This in turn, will help us to improve pre-operative variables (such as compliance or social support) in patients amenable to transplantation and/or to offer alternatives to transplantation in patients with excessive risk factors for poor outcomes. Furthermore, knowing key factors in transplant success will help us to collect relevant data and metrics for ongoing study of these patients. For example, knowing the importance and relative risk of psychiatric disease is critical in ensuring that this factor is measured, studied, and monitored. Applicability: A better understanding of the determinants of transplant outcomes has wide-reaching applicability. This has the potential to help all amputees who may be considering transplantation, since this work will provide a guide as to their likelihood of success, and potential ways in which their chance of a good outcome can be improved. For example, a patient who is older and has other medical problems may be predicted to have a less good outcome and could be informed of this prior to transplantation, thereby helping him or her to make a better decision. Alternatively, we may find that certain immunologic factors are less correlated with poor transplant survival than we currently believe, and this may open the field to more potential transplant recipients. Some psychological factors that correlate with poor outcomes may be modifiable with appropriate pre-transplant therapy that could influence better outcomes. The key clinical application of the proposed project is that each patient and his or her doctors will be better informed about what variables can affect the results of a transplant. Projected Time Frame: We expect each phase of the study to take approximately 1 year of coordination with some overlap, to obtain data, collect additional data where required, and analyze. We expect to see preliminary results and trends at each phase of the study. Contribution to the Military: The United States military?s involvement in conflicts in the Middle East has produced at least 1200 single or multiple extremity amputees; the majority of these individuals are young males. While these patients are generally healthy prior to their injuries, they are well-known to have an over-representation of psychiatric/psychological complications, many of which may contribute to transplant failure. If we are to be able to safely offer transplant to this deserving group, we have the responsibility to know what risk factors patients come with, and to mitigate these by potentially offering treatment or support to maximize successful outcomes. This study will help us to do this. Contribution to the Field of Transplantation: Overall, this work has the ability to better inform all involved in transplantation. In routine me
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Aug 07, 2017
- Source ID
- W81XWH1710400
Entities
People
- Simon G. Talbot
Organizations
- United States Army