Long-term Outcomes Of Full And Partial Facial Transplantation
Elie P. Ramly, MD, Daniel J. Ceradini, MD, Allyson R. Alfonso, BS, BA, Gustave K. Diep, MD, Zoe P. Berman, MD, J. Rodrigo Diaz-Siso, MD, Rami S. Kantar, MD, William J. Rifkin, MD, Michael Sosin, MD, Shane Meehan, MD, G. Leslie Bernstein, MPA, Roberto L. Flores, MD, Jamie P. Levine, MD, Pierre B. Saadeh, MD, David A. Staffenberg, MD, Bruce E. Gelb, MD, Eduardo D. Rodriguez, MD, DDS.
NYU Langone Health, NEW YORK, NY, USA.
Purpose:
There is a paucity of data on the long-term outcomes of face transplant recipients. We present a case series detailing the clinical course and outcomes of 3 patients following full and partial facial transplantation.
Methods:
Three face transplants were performed in 2012, 2015, and 2018 with informed consent and institutional review board approval. Procedural implementation integrated cadaveric rehearsals, computerized surgical planning, and extensive multidisciplinary collaboration. Prospective evaluation of aesthetic, functional, and immunological outcomes was performed.
Results:
All patients continue to have satisfactory facial aesthetic and functional outcomes at follow-up (range: 1.75-7.5 years). Mean number of reoperations for management of short-term complications or elective refinement of functional and aesthetic outcomes was 4.6±2.3 with successful results and no major adverse events. The first acute rejection episode occurred at 22.3±23.8 months (range: 1month–4 years post-transplant), and a total of 1.6±1.1 episodes (range 1-3) of acute rejection were diagnosed per patient and successfully treated. There is no evidence of chronic rejection. One patient developed stage 5 chronic renal disease as a side effect of immunosuppressive therapy. No other major metabolic or infectious complications occurred. Improvement in sensory and motor function was recorded, and patients reported improved quality of life and social reintegration.
Conclusion:
Facial transplantation is a viable solution for patients with facial injury otherwise not amenable to autologous reconstruction. Despite inherent immunological risks, facial transplantation is able to offer substantial long-term improvement in functional, aesthetic, and quality of life outcomes.
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