PURPOSE: The degree to which motor and psychosocial functions may recover following hand and upper-extremity transplantation (HUET) remains unclear. This study quantifies HUET outcome changes in the first 10 years post-transplantation to provide insight into this question.
METHODS: A systematic review of PubMed, Embase, Cochrane, and Medline yielded 2104 records; 118 articles were included in the final review. HUETs above the proximal third of the forearm were designated as proximal and the remaining distal. Semmes-Weinstein Monofilament (SWMF) test, grip strength, Kapandji, finger and thumb total active range of motions (TAROMs), Carroll, Short Form 36 (SF-36), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and Hand Transplantation Score System (HTSS) were recorded according to patient and postoperative year (POY).
RESULTS: Ninety-seven patients were identified between 1998 and 2025. Distal HUETs' SWMF improved from POY1 (4 [4-4]) to POY2 (5 [4-6]). Power grip remained constant for distal and proximal HUETs, but proximal HUETs recovered less than distal HUETs (4.51 ± 1.49 kg vs 7.33 ± 0.71 kg). Lateral pinch strengths did not differ between groups. Proximal HUETs' lateral grips demonstrated sustained improvement after POY3. Bilateral HUETs demonstrated higher SF-36 scores than unilateral HUETs across POY1-10. HTSS measured significant improvements in distal HUETs increasing from 65 (57-79.5) (POY1) to 76 (71-85) by POY3, while proximal HUET only improved from POY1 (61 [45-70.5]) at POY8-10 (82.5 [72-91.5]). Finger TAROMs remained largely unchanged after POY1 while distal and proximal Kapandji thumb opposition scores improved at POY3-6 and POY8-10, respectively.
CONCLUSIONS: Transplant level influenced recovery of power grip and HTSS. HUET power grip strength and finger TAROM stabilized after POY1 while lateral grip, Kapandji scores, HTSS, and SWMF showed improvements in the decade following transplantation, mostly for distal HUETs. Bilateral HUETs had better psychosocial (SF-36) outcomes than unilateral HUETs, but no difference in DASH scores.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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