INNOVATION IN COMPOSITE TISSUE TRANSPLANTATION

L.A. Lantieri¹, P. Grimbert², F. Bellivier³, J.P. Meningaud¹, V. Oudart², M. Hivelin¹, M.D. Benjoar¹, P. Lang^2
1Chirurgie Plastique, Hopital Henri Mondor, CRETEIL/FRANCE, ²Nephrology, CHU Henri Mondor, CRETEIL/FRANCE, ³Psychiatry, CHU Henri Mondor, CRETEIL/FRANCE

Body: Background While the conventional use of autologous transfer allows to reconstruct faces in most cases in some cases conventional surgery fails to restore normal appearance and function leading toindications for facial composite tissue allograft. We report here our series of patients showing the reproducibility, the difficulties, serious adverse events and the outcomes in term of quality oflife. Patients and Methods Five patients were included in a registered clinical research protocol after a thorough clinical, and biological screening, assessed by an independant expert committee.Alternative procedures were discussed for each patient. One patient suffered from bilateral plexiform neurofibromas, two from extensive third degree burns and two from gunshot injuries. As anytransplant they were included national waiting list with a dedicated face procurement procedure. All face transplants were harvested from heart beating brain-dead donors before other tissues andorgans procurements after an alginate molding of the donor's face to allow reconstitution. The induction immunosuppressive regimens included anti-thymocyte globulins, steroids, mycophenolate mophetiland tacrolimus, the maintenance therapy was based on the last three ones. Extracorporeal photopheresis was used as adjuvant immunomodulatory therapy. Results Four patients were transplanted with amaximum follow up of 36 months and minimal of12 months. One patient which was on waiting list for 18 months could not be transplanted due to his panel reactive antibodies . Three patientsexperimented biopsy proven acute cellular rejection episodes easily controlled by conventional treatment. Voluntary facial activity appeared from 3 to 5 month. All patient experienced variousinfections which could be life threatening. These infections were either local or general One of our patient died two month after transplantation due to multi resistant bacterial infection. Thedramatic changes obtained in the facial aesthetic and function and the improvement in patients quality of life had the same extent. Conclusion Face transplantation have been feasible, reproducibleand has allowed major improvement. It represents a change in paradigm in facial reconstruction so as in transplantation.. Infections were always life threatening and were the main pitfall. The needfor civilian and military reconstruction allowing social lives, might led the society to accept these new type of harvested organs and tissues.

Disclosure: All authors have declared no conflicts of interest.