The benefits of face transplants are more than skin deep, according to Brigham investigators who report that patients who have undergone the surgery can feel and move their face five years after transplant.
Since 2009, Brigham surgical teams have performed face transplants for people who have suffered from traumatic facial injuries. The surgery holds the promise of improving physical and mental health for patients who have been severely disfigured and have no other treatment options. In a recent New England Journal of Medicine publication, a Brigham team presented the longer-term outcomes for six patients whose cases had been followed for up to five years after surgery. Overall, patients had a robust return of motor and sensory function of their face, and all but one patient reported improvements in quality of life.
“From the data, you can see the clear benefits that our patients have obtained. It is important to keep in mind that there are no alternative functional prosthetic options for the face,” said co-senior author Bohdan Pomahac, MD, the Roberta and Stephen R. Weiner Distinguished Chair in Surgery and director of Plastic Surgery Transplantation, who led teams that performed partial- and full-face transplants.
“In our previous studies, we reported that patients can speak, eat and breathe better. These aspects are important as well,” Pomahac continued. “Here, we report that the return of motor function is in line with what you would see if you reconnected a severed nerve, and that sensory function appears to improve to near normal. Face transplants have given these patients enough functionality to be able to socially reintegrate in a way that would not have been possible before.”
The team reports that motor function improved significantly both during and after the first post-transplant year, reaching an average of 60 percent of maximal motor function at five years of follow-up. The team also found improvements in the patients’ ability to distinguish between hot and cold stimuli on their skin and respond to pressure testing in the first year after surgery.
An Evolving Field
Pomahac noted that the immunosuppressant medications prescribed after face transplantation and related complications can place a physical, emotional and quality-of-life burden on patients. Investigators are pursuing new ways to improve the patients’ experience and address these challenges.
“The world’s first partial face transplant occurred in 2005 in France, almost 50 years after the first kidney transplant was performed here at the Brigham,” said co-senior author Leonardo Riella, MD, PhD, medical director of the Vascularized Composite Tissue Transplant Program. “Therefore, it is important to realize how young the field of face transplantation really is. While we had used knowledge gained from other solid organ transplants, the face transplant is a complex structure that includes one of the most immunologically challenging tissues of all: the skin. While we have witnessed great success so far, the challenges to minimize immunosuppression toxicity and reduce rejection rates continue.”
Each of the six patients experienced between two and seven acute rejection episodes — in which the patient’s immune system attacked the transplanted tissue — that required treatment. Immunosuppressive drugs can increase risk of diabetes, hypertension or lipid disorders post-transplant, but the team found no new cases of any of these conditions, except for one patient who was diagnosed with hypertension two and a half years after transplantation.
“We are moving beyond the point of asking whether a patient in need will survive receiving a face transplant — we have seen that we can do this safely. We are now asking, ‘Can we quantify how much our patients benefit, and what challenges do we need to work on?’” said Pomahac. “This is the next phase of evolution for this work. Like any new transplantation procedure, we first ask how we can make this safe, and next we ask how we can make this better.”