Abstract
Background
Long-term outcomes after face transplantation are rarely reported in the scientific
literature. Here we present outcome data of a partial face allograft recipient 10
years after transplantation.
Methods
Medical records were reviewed for functional and psychosocial outcomes as well as
complications. Histopathologic analyses of autopsy tissues and characterization of
skin immune cells were performed.
Results
The patient retained long-term motor and sensory function, though with a noticeable
drop in sensory function after year 5. Social reintegration of the patient was marked
by reconnection with his family and participation in public social activities. Immunosuppressive
therapy consisted of tacrolimus (target levels 6–8 ng/mL after the first year), mycophenolate,
and prednisone, while steroids were completely weaned between years 1 and 7. One acute
cellular rejection episode of grade II or higher occurred on average per year and
led to chronic skin changes (papillary dermal sclerosis with superficial hyalinization,
epidermal thinning with loss of rete ridges, perieccrine fibrosis), but the allograft
vessels, muscles, adipose tissue, and bone were spared. Allograft skin was characterized
by increased number of CD4+ TNF-α/IL17A producing T-cells as compared with native
skin. Long-term kidney function was maintained at 60 mL/min estimated glomerular filtration
rate. Unfortunately, the preexisting hepatitis C virus infection with liver cirrhosis
was resistant to 3 treatments with new direct-acting antivirals and eventually hepatocellular
carcinoma developed, causing the patient’s death 10 years after transplantation.
Conclusion
This report suggests that face transplants can maintain their function for at least
10 years. Chronic skin changes can occur independently of allograft vasculopathy.
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Article info
Publication history
Published online: February 26, 2020
Accepted:
January 18,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
