The first human facial allotransplantation, a 38-year-old woman, was performed on November 27, 2005. The aesthetic aspect and functional recovery and the risk-to-benefit ratio are evaluated 5 years later.
The facial transplantation included nose, chin, part of cheeks, and lips. The immunosuppressive protocol included tacrolimus, mycophenolate mofetil, prednisone, and antithymocyte globulins. In addition, donor bone marrow cells were infused on days 4 and 11 after transplantation.
The aesthetic aspect is satisfying. The patient has normal protective and discriminative sensibility. She showed a rapid motion recovery, which has remained stable for 3 years posttransplantation. She can smile, chew, swallow, and blow normally whereas pouting and kissing is still difficult. Phonation recovery was impressive therefore the patient can talk normally. Two episodes of acute rejection developed during the first year. Donor-specific anti-human leukocyte antigen antibodies were never detected. Five-year mucosal biopsy showed a slight perivascular inflammatory infiltrate while skin biopsy was normal. The main side effect of the immunosuppressive treatment was a progressive decrease in renal function, which improved after switching from tacrolimus to sirolimus. Moreover, she developed arterial hypertension, an increase in lipid levels, and in situ cervix carcinoma treated by conization. Since 2008, she showed mild cholangitis possibly caused by sirolimus. In September 2010, bilateral pneumopathy occurred and was successfully treated with antibiotics.
Despite some long-term complications, which are similar to those reported after solid organ transplantation, the patient is satisfied of her new face and has normal social interaction.
1Department of Transplantation, Hôpital Edouard Herriot, HCL, Lyon, France.
2Department of Surgery, University of Cagliari, Cagliari, Italy.
3Service de Chirurgie Maxillofaciale et Stomatologie, CHU-Nord, Amiens, France.
4Department of Dermatology, Hôpital Edouard Herriot, Lyon, France.
5Experimental Morphology Department, Catholic University of Louvain, Brussels, Belgium.
6Burns Unit, Hôpital Edouard Herriot, Lyon, France.
7Institut des Sciences et Techniques de la Réadaptation, Claude Bernard Lyon I University, Lyon, France.
8Department of Immunology, Hôpital Edouard Herriot, Lyon, France.
9INSERM U 851, Université de Lyon, Lyon, France.
The authors declare no funding or conflicts of interest.
Address correspondence to: Palmina Petruzzo, M.D., Department of Transplantation, Hôpital Edouard Herriot 5, place d'Arsonval, 69437 Lyon, France. E-mail: firstname.lastname@example.org or email@example.com
All the authors have collaborated, read, and approved the manuscript. B.L., S.T., and B.D. performed the surgical procedure. J.P.G. and H.P. evaluated sensibility and motion recovery in the follow-up. J.K. performed the biopsies and the histologic studies. The remaining authors managed the patient during the 5 years of follow-up. P.P. collected the data. P.P., J.K., and E.M. wrote the manuscript. J.M.D. and B.D. both have to be considered as “last author” being the coordinator of the transplantation team and the maxilla-facial surgery team, respectively.
Received 26 May 2011. Revision requested 17 June 2011.
Accepted 14 October 2011.