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Surgeons applaud face transplant


Symptoms of redness on the transplanted skin were first believed to be an infection, but a biopsy revealed that the patient's immune system was rejecting the transplanted tissue, according to Jean-Michel Dubernard, M.D., and Bernard Devauchelle, M.D., speaking at their first scientific presentation on the surgery at the 6th International Symposium on Composite Tissue Allotransplantation in Tucson, Ariz. Maria Siemionow, M.D., director of plastic surgery research, Cleveland Clinic (seated), is among surgeons hoping to perform the first face transplant in the United States. Photo: Nancy Melville
Tucson, Ariz. — In the months following a French surgical team's groundbreaking partial face transplant, details have emerged not only about the recipient's identity and appearance, but also about the precarious progress of the surgical outcome.

Among significant developments are that the patient, a 39-year-old French woman whose face had been mauled in a dog attack, experienced a rejection episode about three weeks after the November 2005 surgery in Amiens, France, during which she received a new nose, chin and lips.

Symptoms of redness on the transplanted skin were first believed to be an infection, but a biopsy revealed the cause to be a matter of the patient's immune system rejecting the transplanted tissue, according to surgeons in their first scientific presentation on the surgery at the 6th International Symposium on Composite Tissue Allotransplantation in Tucson, Ariz.

Efforts to treat the problem by increasing the dose of immune-suppressor prednisone were unsuccessful, and the rejection was finally contained only after the doses were increased to high levels.

Another striking revelation was that the patient, who had been a smoker prior to the surgery, had again picked up the habit.

"She is smoking, and this is a problem," says Jean-Michel Dubernard, M.D., a surgeon with Lyons University Hospital in France, who led the procedure.

Smoking issue

Despite the well-known health risks involved with smoking, however, the fact that the patient, Isabelle Dinoire, is smoking may not be as serious a setback as some have suggested, Suzanne Ildstad, M.D., a professor of surgery at the University of Louisville's Institute for Cellular Therapeutics, tells Cosmetic Surgery Times.

"The smoking issue has been sensationalized a bit," she says. "It's bad for you and causes cancer, breathing problems and (a host of other problems), but it shouldn't terribly compromise the tissue acceptance or influence a rejection."

Another transplant

Dr. Ildstad is part of a team at the University of Louisville, where the nation's first hand transplant was performed. The team is working toward performing a face transplant of its own, pending an institutional review board's approval.

"We expect to do a face transplant within the next year or two," she says. A team at the Cleveland Clinic is also well on its way to performing a face transplant.

Dr. Dubernard says that he is so pleased with the progress of his team's transplant that the French team already has plans to perform five more of the procedures.

The key issue for all of the surgeons — to control the immune system so that transplant recipients won't face the serious risks of chronic immunosuppression — was described at the conference as "the Holy Grail" in the field.

Progress 'gradual'

Transplantation pioneer Sir Roy Calne, M.D., of Cambridge University, says progress in the area should come gradually.

"The main challenge now is to improve (transplant) acceptance with less punitive treatment," he says. "There will be progress, but it will likely come in a matter of stages."

Experimentation has had its place in the progress. Several weeks after their face transplant surgery, the French surgeons in Amiens took the unusual step of transplanting the donor's bone marrow in Ms. Dinoire to try to induce better tolerance of the donor tissue.

According to Dr. Ildstad, the strategy was justified. "There's a lot of new data coming out showing that bone marrow reduces chronic rejection — enough data that I think justifies trying it," she says. "The long-term goal, which is part of our work at the University of Louisville, is tricking the immune system so that patients don't need to take any immunosuppressant drugs."


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