A Statistical Comparative Assessment of Face and Hand Transplantation Outcomes to Determine Whether Either Meets the Standard of Care Threshold.

BACKGROUND: Hand and face transplantation has established itself as a clinical option for certain reconstructive problems. The purpose of this study was to carry out a rigorous statistical analysis of all hand and face transplantations to determine whether hand and/or face transplantation is the standard of care.

METHODS: Data from September of 1998 until March of 2014 on all hand and face transplantations in the world were obtained through publications, news articles, personal communications, and presentations. Data on solid organ transplantation were obtained from the Scientific Registry of Transplant Recipients for comparison with the results of hand transplantation. Resampling and permutation statistical analysis was used to compare structured cohorts of hand, face, and solid organ transplantation.

RESULTS: Routine immunosuppression can achieve intermediate- to long-term graft survival in hand transplantation that is empirically superior to solid organ transplantation. Chronic rejection in hand transplantation is statistically significantly less than in solid organ transplantation. Renal failure in hand and face transplantation is empirically less than in solid organ transplantation. Bone marrow transplant with hand transplantation produces both statistically superior and statistically inferior results compared with hand transplantation without bone marrow. In hand transplantation, acute rejection does not seem to increase late allograft loss. The function of hand transplantation is statistically significantly superior to prosthesis yet inferior to hand replantation. Not all hand and face transplants have good results, yet those hand transplants completed within certain parameters obtain excellent results.

CONCLUSIONS: Certain hand transplants arguably can be considered the standard of care. Face transplantation requires more time and patient numbers and a clearer definition of inclusion and exclusion criteria before standard of care assessment can be made.