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Facial transplantation: historical developments and future directions

Published online by Cambridge University Press:  23 March 2015

G L Garrett ,
I Beegun  and
A D'souza
G L Garrett*
Affiliation:
ENT Department, Lewisham Health Care NHS Trust, London, UK
I Beegun
Affiliation:
ENT Department, Royal Free London NHS Foundation Trust, UK
A D'souza
Affiliation:
ENT Department, Lewisham Health Care NHS Trust, London, UK
*
Address for correspondence: Dr Giorgia Louise Garrett, ENT department, Lewisham Hospital NHS Trust, London SE13 6LH, UK E-mail: giorgiagarrett@doctors.org.uk
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Abstract

Objective:

To present the clinical outcomes obtained by the first facial transplant teams worldwide, reviewing current practice and addressing controversies.

Methods:

A bibliographic search of Medline and Embase databases was performed, and a comparative analysis of all articles published from 1980 to the present was conducted. Two independent investigators screened the manuscripts in accordance with pre-defined criteria.

Results:

A total of 12 partial and 5 full facial transplants were recorded in the literature. Procedures included partial and near-total facial myocutaneous flaps, and complex osteomyocutaneous grafts. Fifteen patients had fully vascularised grafts, and two patients died of transplant-related and infectious complications.

Conclusion:

Facial transplantation can restore quality of life and enable the social re-integration of recipients. Results published by the first facial transplant teams are promising. However, long-term reports of aesthetic and functional outcomes are needed to more precisely define outcomes. In addition, significant technical, medical and ethical issues remain to be solved.

Keywords

Facial TransplantationComposite Tissue Allografts
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 3 , March 2015 , pp. 206 - 211
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Devauchelle, B, Badet, L, Lengelé, B, Morelon, E, Testelin, S, Michallet, M et al. First human face allograft: early report. Lancet 2006;368:203–9Google Scholar
2Guo, S, Han, Y, Zhang, X, Lu, B, Yi, C, Zhang, H et al. Human facial allotransplantation: a 2-year follow-up study. Lancet 2008;372:631–8CrossRefGoogle ScholarPubMed
3Lantieri, L, Meningaud, JP, Grimbert, P, Bellivier, F, Lefaucheur, JP, Ortonne, N et al. Repair of the lower and middle parts of the face by composite tissue allotransplantation in a patient with massive plexiform neurofibroma: a 1-year follow-up study. Lancet 2008;372:639–45CrossRefGoogle Scholar
4Siemionow, M, Papay, F, Alam, D, Bernard, S, Djohan, R, Gordon, C et al. Near-total human face transplantation for a severely disfigured patient in the USA. Lancet 2009;374:203–9CrossRefGoogle ScholarPubMed
5Cavadas, PC, Ibanez, J, Thione, A. Surgical aspects of a lower face, mandible, and tongue allotransplantation. J Reconstr Microsurg 2012;28:43–7Google ScholarPubMed
6Lantieri, L, Hivelin, M, Audard, V, Benjoar, MD, Meringaud, JP, Bellivier, F et al. Feasibility, reproducibility, risks and benefits of face transplantation: a prospective study of outcomes. Am J Transplant 2011;11:367–78CrossRefGoogle ScholarPubMed
7Pomahac, B, Pribaz, J, Eriksson, E, Annino, D, Caterson, S, Sampson, C et al. Restoration of facial form and function after severe disfigurement from burn injury by a composite facial allograft. Am J Transplant 2011;11:386–9CrossRefGoogle ScholarPubMed
8Barret, JP, Serracanta, J, Collado, JM, Garrido, A, Salamero, P, Pont, T et al. Full face transplantation organization, development, and results–the Barcelona experience: a case report. Transplant Proc 2011;43:3533–4Google Scholar
9Gomez-Cia, T, Sicilia-Castro, D, Infante-Cossio, P, Barrera-Pulido, F, Gacto-Sanchez, P, Lagares-Borrego, A et al. Second human facial allotransplantation to restore a severe defect following radical resection of bilateral massive plexiform neurofibromas. Plast Reconstr Surg 2011;127:995–6Google Scholar
10Pomahac, B, Pribaz, J, Eriksson, E. Three patients with full facial transplantation. N Engl J Med 2012;366:715–22Google Scholar
11Wu, S, Xu, H, Ravinda, K, Ildstat, ST. Composite tissue allotransplantation: past, present and future – the history and expanding applications of CTA as a new frontier in transplantation. Transplant Proc 2009;41:463–5Google Scholar
12Pomahac, B, Pribaz, J, Bueno, E, Sisk, G, Diaz-Siso, R, Chandawarkar, A et al. Novel surgical technique for full face transplantation. Plast Reconstr Surg 2012;130:549–55CrossRefGoogle ScholarPubMed
13Infante-Cossio, P, Barrera-Pulido, F, Gomez-Cia, T, Sicilia-Castro, D, Garcia-Perla-Garcia, A, Gacto-Sanchez, P et al. Facial transplantation: a concise update. Med Oral Patol Oral Cir Bucal 2013;18:263–71Google Scholar
14Shanmugarajah, K, Hettiaratchy, S, Clarke, A, Butler, PE. Clinical outcomes of facial transplantation: a review. Int J Surg 2011;9:600–7Google Scholar
15Nguyen, L, Naunheim, MR, Hevelone, ND, Diaz-Siso, JR, Hogan, JP, Bueno, EM et al. Cost analysis of conventional face reconstruction versus face transplantation for large tissue defects. Plast Reconstr Surg 2015;135:260–7CrossRefGoogle ScholarPubMed
16Morris, PJ, Bradley, JA, Doyal, L, Earley, M, Hagan, P, Milling, M et al. Facial transplantation: a working party report from the Royal College of Surgeons of England. Transplantation 2004;77:330–8Google Scholar
17Siemionow, MZ, Papay, F, Djohan, R, Bernard, S, Gordon, CR, Alam, D et al. First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries. Plast Reconstr Surg 2010;125:517–22Google Scholar
18Waaga, AM, Gasser, M, Laskowski, I, Tilney, NL. Mechanisms of chronic rejection. Curr Opin Immunol 2000;12:517–21Google Scholar
19Dubernard, JM, Lengelé, B, Morelon, E, Testelin, S, Badet, L, Moure, C et al. Outcomes 18 months after the first human partial face transplantation. N Engl J Med 2007;357:2451–60CrossRefGoogle ScholarPubMed
20Weiss, M, Masden, JC, Rosengard, B, Allan, J. Mechanisms of chronic rejection in cardiothoracic transplantation. Front Biosci 2010;13:2980–8CrossRefGoogle Scholar
21Leonard, DA, Gordon, CR, Sachs, D, Cetrulo, CL. Immunobiology of facial transplantation. J Craniofac Surg 2012;23:268–71Google Scholar
22Mandani, H, Hettiaratchy, S, Clarke, A, Butler, PE. Immunosuppression in an emerging field of plastic reconstructive surgery: composite tissue allotransplantation. J Plast Reconstr Aesthet Surg 2008;62:245–9Google Scholar
23Siemionow, M, Ozturk, C. Face transplantation: outcomes, concerns, controversies, and future directions. J Cranifac Surg 2012;23:254–9Google Scholar
24Mathew, JM, Garcia-Morales, R, Fuller, L, Rosen, A, Ciancio, G, Burke, GW et al. Donor bone-marrow derived chimeric cells present in renal transplant recipients infused with donor bone marrow. I. Potent regulators of recipient antidonor immune responses. Transplantation 2000;70:1675–82Google Scholar
25Barker, JH, Furr, A, Cunningham, M, Grossi, F, Vasilic, D, Storey, B et al. Investigation of risk acceptance in facial transplantation. Plast Reconstr Surg 2006;118:663–70Google Scholar
26Morris, P, Bradley, A, Doyal, L, Earley, M, Hagan, P, Milling, M et al. Facial transplantation: a review of the technical, immunological, psychological and clinical issues with recommendations for good practice. Transplantation 2007;83:109–28Google Scholar
27Genden, EM, Urken, ML. Laryngeal and tracheal transplantation: ethical limitations. Mt Sinai J Med 2003;70:163–5Google Scholar
28Liang, X, Zebrowitz, LA, Zhang, Y. Neural activation in the “reward circuit” shows a nonlinear response to facial attractiveness. Soc Neurosci 2010;5:320–34Google Scholar
29WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects, 2008. In: http://www.wma.net/en/30publications/10policies/b3/index.html [1 December 2013]Google Scholar
30Clarke, A, Butler, PE. Patient selection for facial transplantation II: psychological considerations. Int J Surg 2004;2:116–17CrossRefGoogle ScholarPubMed
31Brill, SE, Clarke, A, Veale, DM, Butler, PE. Psychological management and body image issues in facial transplantation. Body Image 2006;3:1–15Google Scholar
32Renshaw, A, Clarke, A, Diver, AJ, Aschroft, RE, Butler, PE. Informed consent for facial transplantation. Transpl Int 2006;19:861–7Google Scholar
33Hurlburt, M. Facial transplantation: understanding the interests of patients and hurdles to informed consent. Med Sci Monit 2007;13:147–53Google ScholarPubMed
34Clarke, A, Butler, PE. The psychological management of facial transplantation. Expert Rev Neurother 2009;9:1087–100Google Scholar
35Johnson, SE, Corsen, MJ. Facial transplantation in a new era: what are the ethical implications? Curr Opin Otolaryngol Head Neck Surg 2009;17:274–8Google Scholar
36Wolfe, RA, Ashby, VB, Milford, EL, Ojo, AO, Ettenger, R, Agodoa, LY et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999;341:1725–30Google Scholar
37Vasilic, D, Alloway, RR, Barker, JH, Furr, A, Ashcroft, R, Banis, JC Jr et al. Risk assessment of immunosuppressive therapy in facial transplantation. Plast Reconstr Surg 2007;120:657–68CrossRefGoogle ScholarPubMed
38Alexander, A, Alam, D, Gullane, P, Lengelé, B, Adamson, P. Arguing the ethics of facial transplantation. Arch Facial Plast Surg 2012;12:60–3CrossRefGoogle Scholar
39Rumsey, N. Psychological aspects of face transplantation: read the small print carefully. Am J Bioeth 2004;4:22–5CrossRefGoogle ScholarPubMed
40Agich, GJ, Siemionow, M. Until they have faces: the ethics of facial allograft transplantation. J Med Ethics 2005;31:707–9CrossRefGoogle ScholarPubMed
41Lengelé, BG. Current concepts and future challenges in facial transplantation. Clin Plast Surg 2009;36:507–21Google Scholar
42Wiggins, OP, Barker, JH, Martinez, S, Vossen, M, Maldonado, C, Grossi, F et al. On the ethics of facial transplantation research. Am J Bioeth 2004;4:1–12Google Scholar
43Pomahac, B, Diaz-Siso, JR, Bueno, EM. Evolution of indications for facial transplantation. J Plast Reconstr Aesthet Surg 2011;64:1410–16CrossRefGoogle ScholarPubMed
44Siemionow, M, Gordon, CR. Overview of guidelines for establishing a face transplant program: a work in progress. Am J Transplant 2010;10:1290–6CrossRefGoogle Scholar
45Hobson, JE. How the system functions. The roles of the United Network of Organ Sharing, the organ procurement and transplantation network, and the organ procurement organization in heart transplantation. Crit Care Nurs Clin North Am 2001;12:11–21Google Scholar
46Toure, G, Meninguaud, JP, Bertrand, JC, Hervé, C. Facial transplantation: a comprehensive review of the literature. J Oral Maxillofac Surg 2006;64:789–93CrossRefGoogle ScholarPubMed
47Chung, KC, Oda, T, Saddawi-Konefka, D, Shauver, MJ. An economic analysis of hand transplantation in the United States. Plast Reconstr Surg 2010;125:589–98Google Scholar