Last Updated: 2007-12-12 17:00:19 -0400 (Reuters Health)
NEW YORK (Reuters Health) – French clinicians who performed the world’s first partial face transplantation report "satisfactory" functional and aesthetic results 18 months after the procedure.
Dr. Jean-Michel Dubernard, from Hopital Edouard Herriot in Lyon, and colleagues transplanted the face allograft on November 27, 2005 to a 38-year-old woman who had been disfigured by a severe dog bite. The donor was a brain-dead 46-year-old woman who had the same blood group and shared five HLA antigens.
Following surgery, the patient received induction immunosuppression with thymoglobulins in combination with tacrolimus, mycophenolate mofetil, and prednisone. In addition, donor hematopoietic stem cells were given on days 4 and 11, according to the report in The New England Journal of Medicine for December 13. Psychological support was given pre- and post-transplantation.
Sequential biopsy specimens obtained from a sentinel skin graft, facial skin, and oral mucosa were analyzed. Sensory and motor function tests were performed on a monthly basis.
Testing revealed that sensitivity to light touch and to heat and cold had returned to normal by 6 months posttransplantation. Motor recovery took longer; complete mouth closure was achieved at 10 months. Psychological acceptance of the graft correlated with improvements in function.
Graft rejection occurred on posttransplantation days 18 and 214, but was reversible. Extracorporeal photochemotherapy was begun at 10 months to stave off further rejection episodes. Sirolimus was substituted for tacrolimus at 14 months after the clinicians noticed a drop in inulin clearance.
No further rejection episodes have occurred through 18 months of follow-up and the patient reports being satisfied with the aesthetic result.
The investigators note that face transplantations have now been performed in China and again in France.
"More cases will be necessary to allow thorough study of the problems encountered in our patient," the researchers conclude. "Meanwhile, the encouraging 18-month outcomes of face transplantation in our patient suggest that this procedure can offer hope for some patients with severe disfigurement."
N Engl J Med 2007;357:2451-2460.