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From Experimental to Mainstream: A Review of Face Transplantation Over the Past 15 Years
Siddhi Upadhyaya, Rebecca Knackstedt MD PhD, Brian Gastman MD
Cleveland Clinic
2020-02-18
Presenter: Siddhi Upadhyaya
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Brian Gastman, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
Face transplantation (FT) remains the only avenue for repairing extensive facial disfiguration in a single procedure. U.S. insurance companies generally deny coverage, citing their "experimental" nature. The cost of a near-total osteomyocutanous FT in 2008 was estimated to be $250,000-$350,000. In comparison, a 2018 partial osteomyocutaneous FT was estimated to be $1.5 million. This report explores what we know about FTs, and how gaps in data may be improved upon with the ultimate goal of insurance coverage.
Methods:
A systematic review was performed utilizing PubMed for face transplantation. Institution websites, press releases, news reports, and interviews were also utilized. Recipient and donor demographics, blood type, and CMV status were recorded. Details of the injury, extent of deficits, allograft, operation, complications, and cost were documented.
Results:
Forty-seven FTs have been performed by 19 teams in 11 countries from 2005-2019. Average recipient age is 37.89±12.35 years, and average donor-recipient age difference is 14.22±9.39 years. Average time from injury to FT is 7.15±7.09 years. Average operative time is 20.86±8.38 hours, and average ischemia time is 3.11±1.25 hours. Fifteen (31.9%) myocutaneous FTs were performed compared to 31 (66%) osteomyocutaneous FTs. Twenty-eight (59.6%) were partial compared to 18 (38.3%) full FTs. Estimated cost, reported for seven (14.9%) FTs, averaged $468,486±$465,075.
Conclusion:
The limited number of FT cases, coupled with scarcity of data on cost, contribute to insurers' unwillingness to cover FTs. Increased consistency in reporting cost breakdown will provide insurers with the necessary data to decide extent of coverage for FTs moving forward.
