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September 2007 Issue

Rita Alloway, PharmD
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Facial Transplantations May Be Safer Than Previously Thought

By Katie Pence
Published September 2007

It’s common to hear about organ transplantation nowadays, and the boundaries for this life-saving procedure are constantly expanding.

But now, thanks to research conducted at UC and the University of Louisville that shows lower immunosuppressive risks, even facial transplantation could be considered a safe option.

Rita Alloway, PharmD, director of transplant clinical research in nephrology, Steve Woodle, MD, professor of transplant surgery, and colleagues at the University of Louisville, led by John Barker, MD, PhD, professor of surgery and director of plastic surgery research, have discovered that previous data on the risks involved in facial transplantation were misleading.

The latest findings are published in the September edition of the Plastic and Reconstructive Surgery Journal.

The first recorded facial transplant was performed in France in 2005 on a 38-year-old woman whose nose lips and chin had been bitten off by a dog. According to a BBC article, tissues, muscles, arteries and veins were taken from a brain-dead donor and successfully attached to the patient’s lower face.

There have only been two similar attempts since.

In 2004, the British Royal College of Surgeons published a report predicting a high incidence of immunological rejection for facial transplants, data that became a benchmark for facial transplant teams and review boards and greatly influenced the facial transplantation debate. 

According to Woodle, however, the report failed to address several issues.

“The 2004 studies were based on older immunosuppression regimens,” he says. “Modern regimens have much lower rates of rejection.”

It was also a matter of comparing apples to oranges, Woodle suggests.

Both the health status of solid organ transplant recipients and the tissue composition of the solid organs reported in the earlier report are very different from that of face transplant recipients and their facial tissues, he says.

In the new study, the UC-Louisville team looked at immunosuppressive drug regimens for both kidney transplant and hand transplant patients.

When results were compared with facial transplantation, data showed that facial transplantations posed a much lower risk of rejection and immunosuppression-related illness than previously thought.

“Our study goes beyond the 2004 report by taking actual data from tissue recipients into consideration,” Woodle says. “The data provides a better estimate of immunosuppression-related risks when dealing with facial transplantation.”

The risks included rejection, infection, cancer, cardiovascular problems and drug-related toxicities. The new study also examined ways to balance immunosuppression to avoid rejection and to ensure that it wasn’t over- or under-managed.

Alloway, coauthor of the paper, says by working with Louisville’s Barker and his colleagues, the highly controversial idea of facial transplantation could be tamed.

“We’re trying to meld the fields of transplantation and immunosuppression to receive maximum expertise on the subject,” she says. “We’re hoping to decrease toxicity and create a more manageable risk spectrum.”
She adds that oftentimes physicians don’t realize how much risk people will take to gain relief.

“Surveys from transplant professionals have shown that physicians can underestimate what people will do for a cure,” she says. “Often, living disfigured is worse than risk associated with this sort of operation and the immunosuppressive-risks that accompany it.”

Alloway admitted that at first she was unsure about involving herself with facial transplant studies. But one trip to the Cincinnati airport changed her mind.

“As I was riding up the escalator, I saw a young woman,” she says. “I remember, she had a hat on, and I couldn’t see her face at first—but then I saw her.”

Alloway says the woman had been severely burned and that her face was damaged. She later discovered the woman was a UC patient.

“I smiled at that lady,” Alloway says, a grin lighting up her face in remembrance. “I realized then that this was a unique opportunity to contribute to the field, and in this way, potentially help severely disfigured patients.

“We want to provide better assessments of immunosuppression-related risks so that these patients and their surgeons are equipped to make decisions about facial transplantation.” 

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