OUTCOME 5 YEARS AFTER THE FIRST HUMAN PARTIAL FACE TRANSPLANTATION

Palmina Petruzzo¹, Sylvie Testelin², Emmanuel Morelon¹, Lionel Badet¹, Jean Michel Dubernard¹, Jean Kanitakis¹, Maria Brunet¹, Benoit Lengele³, Bernard Devauchelle².

¹Dept of Transplantation Hospices Civils de Lyon, Lyon, France; ²Dept of Maxillofacial Surgery University Hospital of Amiens, Amiens, France; ³Experimental Morphology Department, Catholic University of Louvain, Brussels, Belgium.

Aim of the study was to estimate the aesthetic aspect and functional recovery of the facial graft and the risk to benefit ratio 5 years after the first human facial transplantation (Tx), which consisted of nose, chip and lips.

The initial immunosuppressive protocol included tacrolimus, mycophenolate mofetil, prednisone and antithymocyte globulins. In addition, donor bone marrow (BM) cells were infused on days 4 and 11 after Tx.

Aesthetic and functional recovery was satisfying. She has normal pain and cold sensation. Discriminativerecovery was normal since 2 years after Tx. The analysis of motion recovery showed a rapid improvement of muscle function. After the first year she presented a normal mouth opening, and labial closure is complete despite a persisting light asymmetry. She can smile, chew, swallow and blow normally while pouting and kissing is still difficult. Phonation recovery was impressive and the patient can talk normally.

She presented only two episodes of acute rejection in the first year. Microchimerism was not detected in peripheral blood but was observed in CD34+ BM cells 2 months after Tx. Donor specific anti-HLA antibodies were never detected. Five-year protocol mucosal biopsy showed a slight perivascular infiltrate while skin biopsy was normal.

The main side effect of the immunosuppressive regimen was a progressive decrease in renal function 11 post-tx months that improved after the switch from tacrolimus to sirolimus. In addition, she developed chronic hypertension and increase in lipid levels which were pharmacologically well controlled. Because of an increase in Gamma-GT values a hepatic biopsy was performed showing focal mild biliary lesions and a very slight peri-portal inflammatory infiltrate and no alterations of biliary tree.

Although the reported long-term complications, which are similar to those reported in solid organ transplantation, the patient is very satisfied of her new face and has normal social interaction.