Since 2005, more than 30 face transplant surgeries have been done in the world. However, no documented long-term follow up has been reported.

To fill the gap, a group of French researchers assessed patients who received face transplant and followed their life for about 6 years to identify the risks and benefits of the surgery. The finding is newly published in The Lancet.

In the beginning, researchers found 20 patients with facial defects. Ten of them were selected, and eventually 7 were transplanted: 2 with neurofibromatosis, 1 with a burn, and 4 with self-inflicted facial gunshot injuries.

During the face transplant procedure, the transplanted faces were harvested from heart-beating brain-dead donors. The technique was set up to be standardized, reproducible, and recipient independent.

The transplants were then trimmed to fit the recipient. The facial nerve coaptation was done at the lower or upper branch of the first division in the case of partial transplant or at the facial nerve trunk for full facial transplants.

After the first 6-month follow-up, the clinical assessment was repeated every 3 months, and the supplemental examinations were done at 3 months, 6 months, and 12 months and then every year.

The supplemental examinations included electromyography, skin and mucosa biopsies, viral serologies, liver function tests, blood urea, assessment for donor antibodies, CT and MRI imaging.

Each patient underwent quantitative, self-report health-related quality of life assessment. They were also examined via physical and speech tests, video recording, sensation tests, and psychology tests.

The result showed that among 7 transplanted patients, 1 died on the 65th day after the surgery due to inflection, and 1 died by suicide after struggling with interpersonal and financial problems.

Patients faced an average of 3 revision surgeries. This included removing excess skin, correcting facial palsy, and removing teeth with placement of dental implants. The revisions were generally well tolerated.

All patients experienced acute cell-mediated rejection with grade above 2 between 30 days and 7 years after transplantation. They also suffered from infectious, metabolic and cardiovascular complications.

In the first months after the surgery, complications were infectious, viruses and bacteria caused both systemic and local infections. After the first 3 months, their infections decreased. The late complications were related to low body immune responses.

All patients who survived the early months after the surgery were followed about 6 years. Both the patients and their families were satisfied with the transplants.

Four patients could have good social integration with social support, but 2 patients failed. No time did any of the patients regret having the transplantation. All patients considered their transplant to be their own face, reflecting their personality and emotions. Four patients found part-time or full-time jobs.

About the quality of life, 2 patients had higher physical and mental health scores than average; 1 patient had lower physical health scores, 1 patient had lower mental health scores, and 2 had both lower physical and mental health scores. However, as the time passes, their health was improved.

Researchers suggest that face transplant is a complex surgery and can influence patients’ life significantly. Patients’ social support and pre-existing mental conditions are very important for their life quality after the surgery.

In addition, future surgeries need to consider patient selection, long-term monitoring and strict institutional review board control.

Citation: Lantieri L, et al. (2016). Face transplant: long-term follow-up and results of a prospective open study. The Lancet, In Press, Corrected Proof. doi: http://dx.doi.org/10.1016/S0140-6736(16)31138-2

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