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First Face Transplant Has Encouraging Outcomes


 

After 18 months, the functional and aesthetic outcomes of the first human face transplantation are satisfactory and “encouraging,” according to the physicians who performed the surgery.

It appears that face transplantation “can offer hope” to selected patients who have severe facial disfigurement, they reported in the New England Journal of Medicine.

Dr. Jean-Michel Dubernard of the University of Lyons, France, and his associates previously published the initial results of the partial face transplantation, which they performed in a 38-year-old woman in November 2005. They now report longer-term outcomes.

The woman had been mauled by a dog in May of that year, with her distal nose, upper and lower lips, her entire chin, and the adjacent areas of both cheeks amputated. She received a graft of the lower face from a 46-year-old donor who had the same blood type and all but one of the same HLA antigens.

The recipient's sensory discrimination recovered quickly in the entire skin surface and the oral mucosa, although it remains subnormal. Heat and cold sensation was nearly normal at 4 months and normal at 6 months over the entire graft.

Motor recovery was slower. The patient was unable to close her mouth completely until 6 months post transplant, when that milestone greatly improved pronunciation and mastication. The smile was asymmetrical until 10 months, but became normal by 18 months.

The patient experienced two episodes of acute graft rejection, one 18 days after transplantation and the other 7 months later.

Initial treatment with a standard regimen of oral prednisone, tacrolimus, and mycophenolate mofetil were ineffective, but intravenous boluses of methylprednisolone reversed both of the episodes of rejection.

Extracorporeal photochemotherapy was started to reduce the risk of further graft rejection, and the treatment has been well tolerated.

The woman also developed two infectious complications: type 1 herpes simplex virus of the lips responded to oral valacyclovir and topical acyclovir, and molluscum contagiosum on the cheeks—affecting both the patient's own skin and the allograft skin—was treated by curettage.

The patient's initial immunosuppressive regimen impaired her renal function. This dysfunction was attributed to tacrolimus, which was replaced by sirolimus. Renal function has improved since the switch.

Although the patient has not undergone formal psychological testing, she has gradually resumed a normal social life.

“The progressive return of [facial] expressiveness correlated well with psychological acceptance of the foreign graft,” Dr. Dubernard and his associates said (N. Engl. J. Med. 2007;357:2451–60).

“She is not afraid of walking in the street or meeting people at a party, and she is very satisfied with the aesthetic and functional results,” they noted.

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