Purpose: Little is known about how to measure “success” of upper extremity (UE) vascularized composite allotransplantation (VCA) given its relative novelty and low frequency. While providers define UE VCA “success” as survival, functional, and quality-of-life outcomes, patients’ definitions have been little examined. Our study assessed patients’ definitions of transplant “success”.

Methods: We conducted focus groups among people with acquired UE amputations and UE VCA candidates, participants, and recipients at two sites to assess transplant “success.” Focus group transcriptions were analyzed using thematic analysis. A post-focus group survey assessed demographics.

Results: We conducted 6 focus groups among 26 participants (90% participation rate), including people with acquired UE amputations (n=20), UE VCA candidates who did not pursue it (n=3), a waitlisted UE VCA participant (n=1), and UE VCA recipients (n=2). Most were male (62%), white (85%), and had a unilateral amputation (77%), with a mean age of 49. Transplant “success” was defined in 5 ways: 1) The surgical attachment of the donor limb without complication: “an arm has been transplanted onto your body without rejection”; 2) Restoring function and sensation in the transplanted limb to restore activities: “I can bring a glass to my lips and drink. I can open a door. Turn a doorknob. I can drive my car”; 3) Ensuring the transplant process (e.g., surgery, hand therapy, immunosuppression) ran smoothly: “you’re in rehab and moving forward and making the process work”; 4) Gaining greater function and quality of life with UE VCA compared to no treatment or prosthetics: “How many different tasks can I do with my new hand versus residuals?”; and 5) Ensuring that functional and quality-of-life benefits outweighed the risks (e.g., recovery, side effects, financial): “The addition of the functionality would have to outweigh… whatever other negatives there might be, like recovery time, and what the side effects of the anti-rejection drugs would be”.

Conclusions: Our findings suggest that people with UE amputations define transplant “success” based on desired treatment processes and outcomes, comparing UE VCA to alternatives. Patient-provider discussion about definitions of transplant “success” may help patients determine if UE VCA is the right treatment for them.