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Previous Volume 357:2451-2460 December 13, 2007 Number 24 Next

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ABSTRACT

Background We performed the first human partial face allograft on November 27, 2005. Here we report outcomes up to 18 months after transplantation.

Methods The postsurgical induction immunosuppression protocol included thymoglobulins combined with tacrolimus, mycophenolate mofetil, and prednisone. Donor hematopoietic stem cells were infused on postoperative days 4 and 11. Sequential biopsy specimens were taken from a sentinel skin graft, the facial skin, and the oral mucosa. Functional progress was assessed by tests of sensory and motor function performed monthly. Psychological support was provided before and after transplantation.

Results Sensitivity to light touch, as assessed with the use of static monofilaments, and sensitivity to heat and cold had returned to normal at 6 months after transplantation. Motor recovery was slower, and labial contact allowing complete mouth closure was achieved at 10 months. Psychological acceptance of the graft progressed as function improved. Rejection episodes occurred on days 18 and 214 after transplantation and were reversed. A decrease in inulin clearance led to a change in immunosuppressive regimen from tacrolimus to sirolimus at 14 months. Extracorporeal photochemotherapy was introduced at 10 months to prevent recurrence of rejection. There have been no subsequent rejection episodes. At 18 months, the patient is satisfied with the aesthetic result.

Conclusions In this patient who underwent the first partial face transplantation, the functional and aesthetic results 18 months after transplantation are satisfactory.

Source Information

From Hôpital Edouard Herriot, Université Lyon 1, Centaure Network, Lyon, France (J.-M.D., E.M., L.B., J.-L.B., J.K., A.E.J., P.P., N.L., A.S., D.B., P.G., G.B., O.H., M.M., X.M.); Catholic University of Louvain, Brussels (B.L.); University Hospital, Amiens, France (S.T., C.M., S.D., C.D., F.T., G.D.M., E.C., S.C., B.D.); Hôpital Saint-Louis, Paris (N.P.); and Hôpital Tenon, Paris (C.F.).

Address reprint requests to Dr. Dubernard at the Department of Transplantology, Hôpital Edouard Herriot, 5 Place d'Arsonval, Pavillon V, Lyon 69437, France, or at jean-michel.dubernard{at}chu-lyon.fr.

Full Text of this Article

Related Letters:

Outcomes 18 Months after the First Human Partial Face Transplantation
Guntinas-Lichius O., Dubernard J.-M., Lengelé B., Devauchelle B.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:2179-2180, May 15, 2008. Correspondence

This article has been cited by other articles:

• Guntinas-Lichius, O., Dubernard, J.-M., Lengele, B., Devauchelle, B. (2008). Outcomes 18 Months after the First Human Partial Face Transplantation. NEJM 358: 2179-2180 [Full Text]  
• (2007). First Human Partial Face Transplant. Journal Watch Dermatology 2007: 1-1 [Full Text]