First Face Composite-Tissue Transplant Recipient Successfully Treated for Cytomegalovirus Infection with Preemptive Valganciclovir Treatment

BenMarzouk-Hidalgo, Omar J.; Cordero, Elisa; Gómez-Cía, Tomás; Sánchez, María de la Paz; Gonzalez-Padilla, Juan-David; Infante-Cossio, Pedro; Sicilia-Castro, Domingo; Hernández-Guisado, José-María; Pérez‐Romero, Pilar

doi:10.1128/aac.05335-11

Cited by 27 publications

(18 citation statements)

References 14 publications

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“…Cytomegalovirus mismatches in six patients 12,15,21,32,39 led to ganciclovirresistant and valganciclovir-resistant infection in two patients 21,25 with asymptomatic seropositivity in another. 15 Bacterial infection at the site of operation was reported in three patients (one of whom was co-infected with Candida) 39 and systemically in fi ve. Leucopenia was reported in two patients and treated by reduced immunosuppression and fi lgrastim.…”

Section: Immunological Outcomesmentioning

confidence: 99%

“…14,36 Both recipients of simultaneous upper extremity transplants developed sepsis: 16 one from aspiration pneumonia, leading to bilateral extremity graft loss with salvage of the face, 39 and one from a pseudomonal graft infection at day 12 after surgery that led to cardiac arrest and death. 25 Of two recipients who were mismatched for EpsteinBarr virus, 15,29 one developed a monoclonal B-cell lymphoma at 4 months requiring rituximab and reduction of immunosuppression. 29 No graft-versus-host disease has been reported.…”

Section: Immunological Outcomesmentioning

confidence: 99%

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Facial transplantation: the first 9 years

et al. 2014

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Since the fi rst facial transplantation in 2005, 28 have been done worldwide with encouraging immunological, functional, psychological, and aesthetic outcomes. Unlike solid organ transplantation, which is potentially life-saving, facial transplantation is life-changing. This diff erence has generated ethical concerns about the exposure of otherwise young and healthy individuals to the sequelae of lifelong, high-dose, multidrug immunosuppression. Nevertheless, advances in immunomodulatory and immunosuppressive protocols, microsurgical techniques, and computer-aided surgical planning have enabled broader clinical application of this procedure to patients. Although episodes of acute skin rejection continue to pose a serious threat to face transplant recipients, all cases have been controlled with conventional immunosuppressive regimens, and no cases of chronic rejection have been reported.

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Section: Immunological Outcomesmentioning

confidence: 99%

Section: Immunological Outcomesmentioning

confidence: 99%

Facial transplantation: the first 9 years

et al. 2014

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“…In literature reports, the most common complications were opportunistic infections reported in 8 of 24 patients (14,21,26,27,29,32,46,(64)(65)(66)(67)(68). Metabolic complications, that is, diabetes mellitus occurred in one patient only (22).…”

Section: Complicationsmentioning

confidence: 99%

Functional Outcomes of Face Transplantation

Fischer

Kueckelhaus

Pauzenberger

et al. 2015

American Journal of Transplantation

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In this study we provide a compilation of functional impairments before and improvements after face transplantation (FT) of five FT recipients of our institution and all FTs reported in current literature. Functional outcome included the ability to smell, breath, eat, speak, grimace and facial sensation. Before FT, all our patients revealed compromised ability to breath, eat, speak, grimace and experience facial sensation. The ability to smell was compromised in two of our five patients. Two patients were dependent on tracheostomy and one on gastrostomy tubes. After FT, all abilities were significantly improved and all patients were independent from artificial air airways and feeding tubes. Including data given in current literature about the other 24 FT recipients in the world, the abilities to smell, eat and feel were enhanced in 100% of cases, while the abilities of breathing, speaking and facial expressions were ameliorated in 93%, 71% and 76% of cases, respectively. All patients that required gastrostomy and 91% of patients depending on tracheostomy were decannulated after FT. Unfortunately, outcomes remain unreported in all other cases and therefore we are unable to comment on improvements.

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“…[43,52,54,66,75] It consisted of an "induction" phase, which starts at an early stage of surgery, followed a "maintenance" phase. Most teams employed an induction therapy with polyclonal anti-thymocyte globulins, monoclonal antibody anti-interleukin-2 receptor as daclizumab and basiliximab, anti-CD3 monoclonal antibodies, mycophenolate mofetil, methylprednisolone, and tacrolimus (anti-calcineurin inhibitor).…”

Section: Prevention and Treatment Of Rejectionmentioning

confidence: 99%

“…[63] The majority of patients have suffered from opportunistic infections such as cytomegalovirus, herpes simplex, herpes zoster, candida albicans and bacterial infections, most of them have been treated successfully. [55,75] Due to an increased risk of carcinogenesis in the context of a suppressed immune system, it was likely that a correlation between immunosuppressive medication and the appearance of tumors was established. In this sense, neurofibromatosis type 1 or post-oncological sequelae are indications that may be critically questioned.…”

Section: Post-transplant Revisions and Refinementsmentioning

confidence: 99%

Current role in facial allograft transplantation: what have we learned?

Infante-Cossio¹,

Barrera-Pulido²,

Gómez-Cía³

et al. 2016

PAR

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Face transplant (FT) has evolved enormously in the last 10 years since the successful completion of the first facial transplant. This procedure has become a new reconstructive option for complex facial deformities to restore the anatomy of patients with severely disfigured faces. The authors review the literature and discuss the main surgical, immunological, and ethical aspects as well as the results described in patients undergoing FT. To date there have been more than thirty FT worldwide. The main indication was post-traumatic deformity. In all cases a standard immunosuppression was performed with three drugs, although acute rejection episodes were observed, that could be controlled with conventional immunosuppressive regimen. Overall, functional and aesthetic results have been excellent at short-term and high satisfaction rate exceeded initial expectations, although long-term data are still scarce. Major complications were opportunistic infections. Five deaths that occurred have reopened the ethical debate about the potential complications and concerns of providing informed consent to recipients. Continuous progresses in microsurgical techniques and preoperative planning have promoted the evolution from partial to full FT. All these are on the basis of accurate and careful selection of wellmotivated candidates. The next challenge will be getting new immunosuppressive treatment strategies. Although clinical experience has demonstrated the FT viability, it is still considered an experimental procedure in which we have much to learn to define its true role in the current reconstructive surgery and resolve major technical, medical and ethical problems involved.

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First Face Composite-Tissue Transplant Recipient Successfully Treated for Cytomegalovirus Infection with Preemptive Valganciclovir Treatment

Cited by 27 publications

References 14 publications

Facial transplantation: the first 9 years

Facial transplantation: the first 9 years

Functional Outcomes of Face Transplantation

Current role in facial allograft transplantation: what have we learned?

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