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Clinical Facial Composite Tissue Allotransplantation: A Review of the First Four Global Experiences and Future Implications

Hui-Chou, Helen G. M.D.; Nam, Arthur J. M.D.; Rodriguez, Eduardo D. M.D., D.D.S.

Plastic and Reconstructive Surgery: February 2010 - Volume 125 - Issue 2 - p 538-546
doi: 10.1097/PRS.0b013e3181c722a8
Reconstructive: Head and Neck: Special Topic

Background: Since 2005, seven facial composite tissue allotransplantations have been performed in five different centers in three countries. Four teams have reported their outcomes in separate publications. The authors sought to review the first four global experiences and compare several factors. This review facilitates discussion of indications and future implications for facial composite tissue allotransplantation.

Methods: A thorough review of five publications by the four transplantation groups was conducted. Additional information gathered from official press releases or surgeon presentations was also included. Summary of data and comparative analysis were performed.

Results: Patient selection is of utmost importance; specifically, patient compliance with the immunosuppressive and postoperative regimen. Functional and aesthetic improvement must be achieved by composite tissue allotransplantation reconstruction to justify lifelong immunosuppression; therefore, patients with loss of perioral and/or periorbital structures have priority. Objective measures are required to monitor this functional restoration. The importance of viral mismatch was demonstrated by the severe cytomegalovirus viremia observed in the third facial transplant patient. Finally, the mucosa appears to be a predictor of rejection and is more antigenic than skin. Histopathologic diagnosis of mucosal rejection may allow early treatment and prevention of subsequent diffuse composite tissue allotransplant rejection.

Conclusions: The pioneering teams that ventured into facial composite tissue allotransplantation offered their patients improved aesthetic, functional, and social outcomes not possible with conventional measures in a single procedure. In addition, these innovative facial composite tissue allografts have provided early data on important factors related to patient selection, donor/recipient matching, immunosuppressive protocols, objective measures of functional recovery, and monitoring of acute graft rejection.

Baltimore, Md.

From The Johns Hopkins University School of Medicine and R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine.

Received for publication May 8, 2009; accepted July 28, 2009.

Disclosure: The authors have no financial interests to declare in relation to the content of this article.

Eduardo D. Rodriguez, M.D., D.D.S., Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, Md. 21201-1545,

©2010American Society of Plastic Surgeons