Long-term Follow-up Outcomes after Face Transplantation: The Brigham and Women's Hospital Experience
Sotirios Tasigiorgos, MD1, Marvee Turk, BA1, Branislav Kollar, MD1, Bridget Perry, PhD1, Marie-Christine Nizzi, PhD1, Muayyad Alhefzi, MD2, Ericka M. Bueno, PhD1, Francisco Marty, MD1, Leonardo V. Riella, MD, PhD1, Anil Chandraker, MD1, Stefan G. Tullius, MD, PhD1, Bohdan Pomahac, MD1.
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2McMaster University, Hamilton, ON, Canada.
PURPOSE: Face transplantation (FT) is a single, complex procedure restoring form and function to severely disfigured faces. We report long-term follow-up outcomes in seven FT recipients.
METHODS: We performed a retrospective analysis on seven FT recipients from transplantation date until their maximal follow-up. Outcome measures regarding sensory, motor, functional recovery and quality of life were acquired by providers of respective disciplines at designated time intervals. Analysis of complications included rejection episodes, kidney dysfunction, opportunistic infections, metabolic and oncologic complications. All patients consented to participate in the clinical trial for FT (ClinicalTrials.gov, NCT01281267).
RESULTS: Our patient cohort includes four full-face and three partial-face allografts. Mean follow-up time was 5 years (range 1.5-7 years). Motor and sensory restoration were observed as early as 3 months after transplantation. Sensory data were available for 5/7 patients. Within 2 years post-op, all 5 patients recovered protective, temperature sensation and two-point discrimination in more than 50% of their allografts. Gradual improvement in facial reanimation, tone and symmetry was observed. All allografts were functional, with significant recovery in breathing, speech (90% intelligible) and oral competence. Psychological outcomes were favorable; 5/7 patients returned to work. An average of 6.3 acute rejection episodes per patient was recorded. All patients showed ever-lasting kidney dysfunction. Early and late infections were documented, predominantly of bacterial etiology.
CONCLUSION: Long-term follow-up is paramount, as functional integration of the transplanted face evolves alongside immunological status, nerve regeneration and psychosocial adjustment. FT providers must agree on outcome measures that should be strictly adhered to, and reported.
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