Since 2005, 17 facial allotransplantations have
been performed worldwide. The brief summary of current cases with ongoing
concerns is presented in this article.
METHODS:
Fifteen publications were reported for 10 facial
allotransplantations. For the remaining 7 transplantations, information was
gathered from scientific meeting presentations and media releases. The summary
of current cases in terms of etiology, indications, results, complications, and
outcomes are based on these data. The discussion of ongoing concerns,
controversies, and overview of future implications is accomplished by reviewing
the literature of ethical debates, experimental studies, clinical studies, and
personal opinion.
RESULTS:
Two of the 17 face transplant recipients died.
Overall survival rate was 88%. No early graft loss due to technical failure was
reported. All reported cases that have more than 1-year follow-up had at least
1 acute rejection episode, which was reversible with treatment. Opportunistic
infections and metabolic complications were observed as adverse effects. Motor
recoveries were slower than the sensorial recoveries, as expected. Functional
and aesthetic outcomes were satisfactory. Concerns and controversies about
concomitant face and hand transplantation, recipient blindness, recipient age,
primary reconstruction option in facial trauma cases, funding, graft failure
risks, and future treatment options are discussed.
CONCLUSIONS:
Because of uncertainty about long-term outcomes,
immunosuppression-related concerns and ethical debates limit worldwide
application of facial allotransplantation. However, in selected group of
patients, it is a unique reconstruction method with promising outcomes. Further
research and investigation in transplant immunology and treatment hold the key
to advance this treatment option.
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