Full Face Transplants Transform Victims Lives

A new study describing the largest series worldwide of full-face transplantation (FFT) details patient preparation, design and execution of the operation, as well as a unique immune-suppression protocol that allows for a low long-term maintenance drug regimen.

A surgical team at Brigham and Women's Hospital (BWH; Boston, MA, USA) documented FFT process, from screening candidates to the transplant procedure itself and the follow up management of the recipients. The process includes evaluation by a team of physicians that determine whether the patient is prepared physically and mentally for the procedure through numerous clinical and psychological evaluations. Once a candidate is approved by the face transplant team, the physicians work closely with the New England Organ Bank (NEOB) to identify the criteria for suitable donors and the process for obtaining consent for the transplantation.

Next, the researchers outlined the details of the surgeries, with a focus on the multidisciplinary collaborative efforts of an entire team of clinicians. Surgeons and staff coordinate their tasks while preparing the recipient, simultaneously retrieving the donor tissue within a limited time frame. The researchers described the similarities and difference between each procedure, noting the various differences that occurred in the one FFT recipient who also concurrently received a bilateral hand transplant.

Lastly, the researchers explained the care of the recipient posttransplant. Following the surgery, physicians monitor and adjust immunosuppressants while methodically screening for any signs of organ rejection. The researchers also discussed the occurrence of single rejection episodes in two patients, as well as describing how the transplanted tissue transformed and adapted to match the features of the recipient in each case. They also shared details of the early functional outcomes and discussed FFT as a viable option in the treatment of severe facial deformities and injuries. The study was published ahead of print on December 28, 2011, in the New England Journal of Medicine (NEJM).

“Unlike conventional reconstruction, facial transplantation seeks to transform severely deformed features to a near-normal appearance and function that conventional reconstructive plastic surgical techniques cannot match,” said lead author Bohdan Pomahac, MD, director of the plastic surgery transplantation program at BWH and lead surgeon in all three FFT procedures. “It truly is a life-giving procedure for these patients.”

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Brigham and Women's Hospital