Face Transplantation in a Black Patient — Racial Considerations and Early Outcomes

Kauke, Martin; Tchiloemba, Bianief; Diehm, Yannick; Haug, Valentin; Kollar, Branislav; Perry, Bridget J.; Singhal, Dhruv; Sinha, Indranil; Riella, Leonardo V.; Annino, Donald J.; Pomahač, Bohdan

doi:10.1056/nejmc2033961

Cited by 22 publications

(26 citation statements)

References 5 publications

(4 reference statements)

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“…Regarding cytomegalovirus (CMV) and Epstein-Barr virus (EBV) serologies, EBV status mismatch between FT recipient and donor served as an exclusion criterion for 2 programs (8%) 93,108 and CMV-positive donor/CMV-negative recipient (CMV D+/R−) mismatches were absolute exclusion criteria for 2 programs (8%) 108,115 . Nevertheless, FT has been performed on both CMV-positive and EBV-positive patients 54,93,106,108 . Four programs (17%) have performed FT in a CMV D+/R− pair, 41,45,69,79,80 with one of these programs later recommended against CMV D+/R− FTs 69 .…”

Section: Resultsmentioning

confidence: 99%

“…108,115 Nevertheless, FT has been performed on both CMV-positive and EBV-positive patients. 54,93,106,108 Four programs (17%) have performed FT in a CMV D +/R− pair, 41,45,69,79,80 with one of these programs later recommended against CMV D+/R− FTs. 69 For the remaining 16 centers, CMV or EBV status for either recipient or donor were not mentioned in their recipient criteria (67%).…”

Section: Pathologic/physiologic Considerationsmentioning

confidence: 99%

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Recipient Selection Criteria for Facial Transplantation

et al. 2022

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BackgroundRecipient selection is an important determinant of surgical outcomes in facial transplantation (FT). Appropriately, each FT program develops their own guidelines for recipient selection criteria. Currently, there is no resource to simultaneously assess and identify similarities and differences between these guidelines. Such information could be useful in distinguishing areas of FT that are well understood from those that could benefit from further exploration.MethodsWe performed a systematic review of the scientific literature from inception to June 18, 2021, using Pubmed, Embase, Cochrane Library, and Scopus to identify articles pertaining to recipient selection criteria. Clinical trials were identified through the Clinicaltrials.gov registry. United States and international program websites were reviewed for patient-facing information.ResultsOur systematic review yielded 90 suitable articles, 8 clinical trials, and 7 program websites containing the recipient selection criteria of 24 different FT programs. The most reported on recipient criteria were age, positive human immunodeficiency viral status (HIV+), positive hepatitis C viral status, psychosocial stability, and medical compliance. Other criteria were rarely addressed, such as blindness and recipient immune status.ConclusionsGuidelines among different face transplant programs are changing over time. We found consensus on certain recipient selection criteria, but the majority remain program or surgeon dependent, emphasizing that FT is still an evolving procedure. Although most programs reported on their recipient selection criteria, the rationale was often missing. Further discussion about recipient selection criteria and the reasoning behind employing or changing them will help advance the field.

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Section: Resultsmentioning

confidence: 99%

Section: Pathologic/physiologic Considerationsmentioning

confidence: 99%

Recipient Selection Criteria for Facial Transplantation

et al. 2022

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“…Accuracy of rejection detection on different skin colors, an important consideration for software-based image analysis of patients with FT, may be reduced on darker skin tones. 41 Despite our institution performing the first full-face transplant on a black patient, 42 we were unable to include his data due to having less than 2 years of follow-up data required by the study inclusion criteria. However, he remains one of two black patients with FT worldwide, highlighting the troubling duality racial disparities play in the field of transplantation [43][44][45] -decreased patient access leads to decreased information of patient outcomes.…”

Section: Future Directionsmentioning

confidence: 99%

Software-based Detection of Acute Rejection Changes in Face Transplant

Dorante

Kollar

Bittner³

et al. 2021

J Reconstr Microsurg

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Background An objective, non-invasive method for redness detection during acute allograft rejection in face transplantation (FT) is lacking. Methods A retrospective cohort study was performed with 688 images of 7 patients with face transplant (range, 1 to 108 months post-transplant). Healthy controls were matched to donor age, sex, and had no prior facial procedures. Rejection state was confirmed via tissue biopsy. An image-analysis software developed alongside VicarVision (Amsterdam, Netherlands) was used to produce R, a measure of differences between detectable color and absolute red. R is inversely proportional to redness, where lower R values correspond to increased redness. Linear mixed models were used to study fixed effect of rejection state on R values. Estimated marginal means of fitted models were calculated for pairwise comparisons. Results Of 688 images, 175, 170, 202, and 141 images were attributable to Banff Grade 0,1,2, and 3, respectively. Estimated change in R value of facial allografts decreased with increasing Banff Grade (p = 0.0001). The mean R value of clinical rejection (Banff Grade ⅔) (16.67, 95% Confidence Interval [CI] 14.79–18.58) was lower (p = 0.005) than non-rejection (Banff Grade 0/1) (19.38, 95%CI 17.43–21.33). Both clinical and non-rejection mean R values were lower (p = 0.0001) than healthy controls (24.12, 95%CI 20.96–27.28). Conclusion This proof-of-concept study demonstrates that software-based analysis can detect and monitor acute rejection changes in FT. Future studies should expand on this tool's potential application in telehealth and as a screening tool for allograft rejection.

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“…3 Furthermore‚ the long-term survival of the allograft can be subject to acute and chronic graft rejection in solid organ transplantation (SOT) and vascularized composite allotransplantation (VCA), such as face, hand, penile, or abdominal wall transplants. 1,[4][5][6][7][8][9][10] Given the higher rate of diagnosed acute rejection episodes in up to 85% of VCA recipients, the link between long-term allograft survival and rejection episodes could theoretically even be more pronounced in VCA. 11 One approach to optimizing this risk-benefit ratio is the development of therapies allowing for safe reduction of immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Regulatory T Cells: Liquid and Living Precision Medicine for the Future of VCA

Kauke

Knoedler

et al. 2022

Transplantation

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Transplant rejection remains a challenge especially in the field of vascularized composite allotransplantation (VCA). To blunt the alloreactive immune response‚ stable levels of maintenance immunosupression are required. However‚ the need for lifelong immunosuppression poses the risk of severe side effects, such as increased risk of infection, metabolic complications, and malignancies. To balance therapeutic efficacy and medication side effects, immunotolerance promoting immune cells (especially regulatory T cells [Treg]) have become of great scientific interest. This approach leverages immune system mechanisms that usually ensure immunotolerance toward self-antigens and prevent autoimmunopathies. Treg can be bioengineered to express a chimeric antigen receptor or a T-cell receptor. Such bioengineered Treg can target specific antigens and thereby reduce unwanted off-target effects. Treg have demonstrated beneficial clinical effects in solid organ transplantation and promising in vivo data in VCAs. In this review, we summarize the functional, phenotypic, and immunometabolic characteristics of Treg and outline recent advancements and current developments regarding Treg in the field of VCA and solid organ transplantation.

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Face Transplantation in a Black Patient — Racial Considerations and Early Outcomes

Abstract: In 2019, we performed what we believe to be the first full-face transplantation in a Black patient. The patient was a 67-year-old man who had burns over 50% of his total body-

Cited by 22 publications

References 5 publications

Recipient Selection Criteria for Facial Transplantation

Recipient Selection Criteria for Facial Transplantation

Software-based Detection of Acute Rejection Changes in Face Transplant

Regulatory T Cells: Liquid and Living Precision Medicine for the Future of VCA

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