Three Patients with Full Facial Transplantation

Pomahac, Bohdan; Pribaz, Julian J.; Eriksson, Elof; Bueno, Ericka M.; Diaz-Siso, J. Rodrigo; Rybicki, Frank J.; Annino, Donald J.; Orgill, Dennis P.; Caterson, Edward J.; Caterson, Stephanie A.; Carty, Matthew J.; Chun, Yoon S.; Sampson, Christian E.; Janis, Jeffrey E.; Alam, Daniel S.; Saavedra, Arturo; Molnár, Joséph; Edrich, Thomas; Marty, Francisco M.; Tullius, Stefan G.

doi:10.1056/nejmoa1111432

Cited by 227 publications

(213 citation statements)

References 19 publications

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“…Nasal receptors trigger spontaneous ventilation, so that chronic changes in nasal airflow provoke apneic episodes and hypoxia (7,8). Anatomical deficits in the upper airway result in decreased airway volume, increased airway resistance and ultimately dependency on a tracheostomy tube for respiration (4). In one of our recent studies we investigated effects of FT on airway recovery (Fischer et al, Boston, MA, USA, submitted April 2014).…”

Section: Discussionmentioning

confidence: 99%

“…The search terms were ''facial graft,'' ''facial transplantation,'' and ''facial allotransplant''; the time frame was between January 2000 and March 2014. Articles were in English language and contained at least one case report of FT. We identified 28 articles fulfilling these criteria (1,4,5,.…”

Section: Peer-reviewed Literaturementioning

confidence: 99%

“…FT cannot restore lost sight, but it can restore normalcy to the sense of smell by means of reconstruction of the nasal passage (4). Facial expression and speech are mandatory for communication.…”

Section: Introductionmentioning

confidence: 99%

“…Patients with severe facial injuries suffer from leakages of the oral cavity, trismus and absence of masseter muscles and thus are often unable to adequately ingest solid foods, liquids or even their medications (4). This ultimately leads to insertion of feeding tubes or gastrostomy, provoking significant discomfort, potential for malnutrition, infection, bleeding and possibly death (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…We use simple descriptions and clearly visible changes to define common denominators of functional outcomes and thus generate an adequate basis for comparison. (4,19). Perioperative information for the five patients is given in Table 1.…”

Section: Introductionmentioning

confidence: 99%

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Functional Outcomes of Face Transplantation

Fischer

Kueckelhaus

Pauzenberger

et al. 2015

American Journal of Transplantation

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In this study we provide a compilation of functional impairments before and improvements after face transplantation (FT) of five FT recipients of our institution and all FTs reported in current literature. Functional outcome included the ability to smell, breath, eat, speak, grimace and facial sensation. Before FT, all our patients revealed compromised ability to breath, eat, speak, grimace and experience facial sensation. The ability to smell was compromised in two of our five patients. Two patients were dependent on tracheostomy and one on gastrostomy tubes. After FT, all abilities were significantly improved and all patients were independent from artificial air airways and feeding tubes. Including data given in current literature about the other 24 FT recipients in the world, the abilities to smell, eat and feel were enhanced in 100% of cases, while the abilities of breathing, speaking and facial expressions were ameliorated in 93%, 71% and 76% of cases, respectively. All patients that required gastrostomy and 91% of patients depending on tracheostomy were decannulated after FT. Unfortunately, outcomes remain unreported in all other cases and therefore we are unable to comment on improvements.

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Section: Discussionmentioning

confidence: 99%

Section: Peer-reviewed Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional Outcomes of Face Transplantation

Fischer

Kueckelhaus

Pauzenberger

et al. 2015

American Journal of Transplantation

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Combined Whole Eye and Face Transplant

Ceradini,

Tran,

Dedania

et al. 2024

JAMA

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ImportanceCatastrophic facial injury with globe loss remains a formidable clinical problem with no previous reports of reconstruction by whole eye or combined whole eye and facial transplant.ObjectiveTo develop a microsurgical strategy for combined whole eye and facial transplant and describe the clinical findings during the first year following transplant.Design, Setting, and ParticipantA 46-year-old man who sustained a high-voltage electrical injury with catastrophic tissue loss to his face and left globe underwent combined whole eye and face transplant using personalized surgical devices and a novel microsurgical strategy at a specialized center for vascularized composite allotransplantation.Main Outcomes and MeasuresReperfusion and viability of the whole eye and facial allografts, retinal function, and incidence of acute rejection.ResultsThe patient underwent a combined whole eye and face transplant from an immunologically compatible donor with primary optic nerve coaptation and conventional postoperative immunosuppression. Globe and retinal perfusion were maintained throughout the immediate postoperative period, evidenced by fluorescein angiography. Optical coherence tomography demonstrated atrophy of inner retinal layers and attenuation and disruption of the ellipsoid zone. Serial electroretinography confirmed retinal responses to light in the transplanted eye. Using structural and functional magnetic resonance imaging, the integrity of the transplanted visual pathways and potential occipital cortical response to light stimulation of the transplanted eye was demonstrated. At 1 year post transplant (postoperative day 366), there was no perception of light in the transplanted eye.Conclusions and RelevanceThis is the first report of whole eye transplant combined with facial transplant, demonstrating allograft survival including rejection-free graft survival and electroretinographic measurements indicating retinal response to light stimuli. These data highlight the potential for clinical allotransplantation for globe loss.

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The Evolving Clinical Presentation of Acute Rejection in Facial Transplantation

Haug

Kollar

Obed

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Acute rejection is one of the most frequent complications in facial transplantation, with potentially severe consequences for the recipient if overlooked. Clinical signs, such as erythema or edema, are helpful to diagnose acute rejection in the early follow-up stage; however, it is not well known whether these clinical signs remain reliable markers of acute rejection beyond the second posttransplant year. OBJECTIVE To determine the diagnostic value of clinical signs of acute rejection after facial transplantation over time. DESIGN, SETTING, AND PARTICIPANTS A retrospective, single-center cohort study was conducted of patients who underwent facial transplantation at Brigham and Women's Hospital between April 2009 and October 2014, with up to an 8-year follow-up. Medical records were reviewed until September 30, 2017. The medical records from 104 encounters with 7 patients who underwent partial or full facial transplantation were analyzed for symptoms of rejection, immunosuppressive therapy, and histopathologic findings. MAIN OUTCOMES AND MEASURES The occurrence of 5 clinical signs of acute rejection were evaluated: erythema, edema, exanthema, suture line erythema, and mucosal lesions. Odds ratios (ORs) were calculated to determine the statistically significant association of these signs with the histopathologic diagnosis of rejection. In addition, tacrolimus blood levels, as a surrogate marker of immunosuppressive therapy, were evaluated. RESULTS Of the 7 patients included in the study, 5 were men. The mean follow-up was 66 months (range, 35-101). Of 104 clinical encounters, 46 encounters (44.2%) represented rejection episodes and 58 encounters (55.8%) represented no-rejection episodes. Beyond 2 years posttransplantation, only erythema (OR, 6.53; 95% CI, 1.84-20.11; P = .004) and exanthema (OR, ϱ; 95% CI, 2.2-ϱ; P = .004) were demonstrated to be reliable clinical signs of acute rejection in facial transplantation. There was also a statistically significant association of subtherapeutic tacrolimus levels with late rejection episodes (OR, 3.79; 95% CI, 1.25-12.88; P = .03). In addition, the occurrence of subclinical rejection was more frequent during later follow-up times (7 [24.1%] late rejections vs 1 [5.9%] early rejection). Five of 8 subclinical rejections (62.5%) were associated with subtherapeutic tacrolimus levels. CONCLUSIONS AND RELEVANCE Clinical signs of acute rejection in facial transplantation appear to be of limited diagnostic value, particularly after the second postoperative year. Until alternative biomarkers for rejection are identified, protocol skin biopsies will remain necessary for guiding assessments of allograft rejection. LEVEL OF EVIDENCE 3.

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Three Patients with Full Facial Transplantation

Cited by 227 publications

References 19 publications

Functional Outcomes of Face Transplantation

Functional Outcomes of Face Transplantation

Combined Whole Eye and Face Transplant

The Evolving Clinical Presentation of Acute Rejection in Facial Transplantation

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