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 “Ultimately, if one answers, ‘yes’ to the question, ‘Should we
continue performing face transplants?’” then the “ethical
requirements” for going forward include carefully determining which
patients are likely to benefit and which are not, long-term
monitoring to track what happens, and strict oversight by the
hospital’s institutional review board, the authors wrote in The
Lancet.
There have been fewer than 40 face transplants since 2005. In the
new study, the French research team followed outcomes for seven
transplant patients who had the surgery at their hospital between
2000 and 2009. Four had self-inflicted gunshot wounds to the face,
one was burned and two had an inherited facial tumor condition.
A study of seven people is relatively large when you consider that
so few transplants have ever been done, lead author Laurent Lantieri
of the Hopital Européen Georges Pompidou in Paris told Reuters
Health by phone.
Over several years of follow-up, two patients died, one due to
transplant failure and infection and one due to suicide more than
three years after the transplant.
As with other organ and tissue transplants, recipients’ immune
systems periodically rejected the new tissue, and the powerful
immunosuppressive drugs that lower the risk of rejection
unfortunately increased the high risk of metabolic side effects.
The surviving patients continued to take high-dose steroids to
combat rejection episodes years after surgery. None developed
diabetes, which is a common side effect of steroids, but three
developed high blood pressure and all had noticeably reduced kidney
function.
Not all recipients experienced the same improvement in quality of
life or social integration. Improvements in those areas seemed to
depend on patients’ quality of life before the transplant, and
whether or not they had serious psychiatric conditions before
surgery.
Mental health is an important predictor of the success or failure of
a face transplant, and recipients should be carefully selected and
have mental health and social work professionals in their
multidisciplinary transplant teams, according to Dr. J. Rodrigo
Diaz-Siso and Dr. Eduardo D. Rodriguez of New York University
Langone Medical Center, one of the few facilities in the world where
face transplants are performed. Diaz-Siso and Rodriguez coauthored a
comment along with the new research in The Lancet.
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Also critically important to the success of a face transplant is
so-called HLA matching, that is, making sure the donor and the
recipient tissues are immunologically compatible.
“A face transplant requires lifelong adherence to a pharmacological
regimen of immunosuppressants,” Rodriguez told Reuters Health by
email. “That is why it is critically important to select patients
who are committed to compliance, have a support system to hold them
accountable, and understand the potential side effects of these
medications.”
The authors of the study and of the comment agree that what
long-term data we have so far does not yet answer the question,
“Should we continue performing these procedures?”
“Face transplantation is not Face/Off,” Lantieri said, referring to
a 1990s science fiction movie. “These patients have no other options
and face incredible risks just to improve their basic quality of
life, unlike what has been shown in the media.”
“Face transplants are appropriate for a select group of individuals,
particularly for those for whom conventional plastic surgery options
have been exhausted and function has not yet been restored,”
Rodriguez said. “These individuals must also understand the risks of
these types of these procedures as well as the long term effects of
immunosuppression medication.”
SOURCE: http://bit.ly/2bZJ1rW and http://bit.ly/2ctld1m The Lancet,
online August 24, 2016.
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