Long-term outcomes good for face transplant recipients, study finds

Since the operation was first performed in 2005, 50 face transplants have been performed in 11 countries, and a new study shows that the long-term results are favorable.

Research shows that 85% of people who underwent such a complex operation survived five years and 74% were still alive ten years after the transplant.

When the figures focus on deaths related to transplants themselves, the five- and 10-year survival rates rose to 96% and 83%, respectively.

That’s significantly better than survival for other types of transplants, the team of Finnish researchers said. For example, 10 years after surgery, survival for liver transplants reaches 61 percent and for heart transplants, it’s 65 percent, they noted.

“The world’s first 50 face transplants over an 18-year period show promising graft survival rates, which are higher than those of multiple solid organ transplants,” concluded a team led by Dr. Pauliina Homsy from the Department of Plastic Surgery, University of Helsinki.

Her team published their report of September 18 in the magazine JAMA Surgery.

Homsy’s team collected data on all 50 face transplants performed on 48 patients, conducted at 18 centers in 11 countries. Two of the patients required a second transplant, which in each case proved successful, the researchers noted.

The study found that nineteen patients underwent surgery in North America (18 in the United States), 29 in Europe, 1 in China, and 1 in Russia.

Most (81%) patients were male. In 58% of cases, an injury/trauma resulted in disfigurement that necessitated facial transplantation. Burns were the cause of another 22% of facial transplants.

In 52% of cases a complete face transplant was required and in 48% of cases only part of the face was restored.

As with any transplant, the body’s immune system can attack the new tissue, so patients often have to take anti-rejection medication for a long time.

Of the six face transplants considered to have failed (over an average of nine years of follow-up), rejection by the immune system was the cause in four cases.

Homsy’s team stressed that there’s a lack of research on other outcomes. Those outcomes include how well the new face might function over time; whether there are long-term risks for disease (such as heart disease, diabetes or cancer); and the mental health implications of navigating the world with a new face.

Drs. Kristen Stephen and Scott Hollenbeck, plastic surgeons at the University of Virginia in Charlottesville, wrote an editorial accompanying the new review. They note that the world’s first face transplant was performed in France in 2005, after a 46-year-old woman living in Lyon was seriously injured in a dog attack.

Surgeons “restored” her nose and mouth, which were lost in the attack, and the patient continued to recover. She died of lung cancer in 2016.

“The remarkable recovery of the Lyon patient shows that there are possibilities to restore both form and function through such transplants,” the experts said.

According to Stephen and Hollenbeck, face transplants have only become more advanced since then.

“Most of these patients initially suffered catastrophic trauma and have exhausted traditional reconstructive options,” they wrote. “As this specialty has evolved, more patients have received bone constructs and larger skin surfaces within their grafts.”

There is indeed a kind of “global learning curve for face transplants,” they say, with survival rates increasing in all centers where these delicate operations are performed.

But the two experts also point to one barrier: the cost of these very expensive surgeries and their follow-up. They note that after a peak in face transplants in 2011-2014, their numbers have fallen.

“In an era of value-based care and cost containment, it is challenging for many hospitals to start or maintain programs that include face transplantation,” Stephen and Hollenbeck concluded.

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