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Eight-year Follow-up on the First Face transplant in the United States and the Longest Living Composite Tissue Allograft Containing Vascularized Bone
Rebecca Knackstedt, MD, PhD; James Gatherwright, MD; Frank Papay, MD; Steven
Bernard, MD; Graham Schwarz, MD; Brian Gastman, MD; Antonio Rampazzo, MD, PhD; Bahar
Bassiri, MD, PhD; Mark Hendrickson, MD; Maria Siemionow, MD, PhD; Risal Djohan MD
Cleveland Clinic
2017-01-30
Presenter: Rebeccca Knackstedt
Affidavit:
Steven Bernard
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
On December 9, 2008, the first near-total human face transplant was performed in the United States on a 45-year old female who had incurred a close range ballistic injury. The current study provides an eight-year follow-up.
The patient continues to demonstrate improvements in anxiety, depression, and re-integration; however, self-esteem and sexual function continue to not be much improved. Speech intelligibility is 90-100% with some mild dysarthria and decreased articulatory precision. Her transplant medication regimen has been decreased to Mycophenolate Mofetil 500 mg TID, Tacrolimus 1mg BID and Prednisone 5mg. The patient has been admitted seventeen times, resulting in 143 hospital days. She has had sixteen procedures; eight of which were ophthalmology related. Her most recent operation was in November 2016 for a right orbital implant exposure/removal. There have been three acute rejection episodes, occurring 47 days, 92 months, and approximately 4.5 years after surgery, all of which were successfully treated with steroids and short term medication adjustments.
This is the first report on the long-term outcomes of the oldest living face transplant in the United States. Our patient represents the longest follow-up in an individual who received composite transplant including vascularized bone. Despite three acute rejection episodes and several infectious complications, her overall health has been relatively well maintained with continued management via the lowest possible regimen of immunosuppression. Continued objective evaluation of these results both on an institutional and international level are required to provide better understanding, improved outcomes, and justification of this procedure.
