Table 2.

Comparison of similarities and differences between hand replantation and transplantation.

	Hand replantation	Hand transplantation
1. Motor	● No cognitive therapy required	● Nerve regeneration stimulated by immunosuppressive medications ● Cognitive therapy required
	● Similar recovery of digit and wrist ranges of motion ● Faster and improved extrinsic muscle recovery versus intrinsic ● Avulsion/crush amputations associated with worse outcomes in comparison with sharp
2. Sensation	● Near 100% protective sensation ● 30%–60% tactile and discriminatory	● 100% protective sensation ● 80%–90% tactile and discriminatory
	● 2-PD < 10 mm ● More distal amputation associated with faster recovery ● Common cold intolerance
3. Cosmesis	● No tissue matching required ● More significant scarring with less restoration of soft tissues ● Higher risk of unequal UE lengths due to bone shortening	● Size, gender, age, and skin color matching issues ● Less significant scarring with better restoration of soft tissues ● Lower risk of unequal lengths
4. Patient satisfaction/quality of life	● Majority with improved self-reported quality of life ● Lower patient satisfaction	● 75% self-reported improvements in quality of life ● Higher patient satisfaction
	● Many resumed suitable work without primary use of injured hand
5. Adverse events/complications	● Most common cause of replantation failure is arterial insufficiency (60%) ● Second most common cause is venous insufficiency (20%) ● Overall higher rates of failure	● Most common cause of transplantation failure is rejection secondary to treatment non-compliance (China) ● One reports of chronic rejection ● Four other reported failures due to severe infection, intimal hyperplasia, and acute rejection (Western countries) ● 85% of reported cases have an episode of acute rejection (all but one case reversed with treatment) ● Immunosuppression-related side effects
	● Similar delays in bone union ● Common long-term complications include neuroma formation and tendon adhesions
6. Financial costs	● Unilateral lifetime cost = US$42,561 ● (range = US$784–US$596,457)	● Unilateral lifetime cost = US$509,275 ● Bilateral lifetime cost = US$529,395
	● Difficult to evaluate and compare costs accurately due to the variety of components
7. Overall function	● Improvements after 5 years limited to cold intolerance and SW monofilament sensation ● Majority return to at least 50% of overall original function	● Improving HTSS and DASH scores over 12–13 years ● HTSS scores are generally excellent ● DASH scores generally show significant reductions in disabilities
	● Majority of Chen scores are Grades II (good) to III (fair)

UE: upper extremity; HTSS: Hand Transplantation Score System; DASH: Disabilities of the Arm, Shoulder, and Hand; 2-PD: two-point discrimination.