Face transplantation

2019 ◽  
pp. 379-382
Author(s):  
Indranil Sinha ◽  
Raj M. Vyas ◽  
Bohdan Pomahac
Keyword(s):  
Self Report ◽  
Dramatic Improvement ◽  
Post Transplantation ◽  
Composite Tissue Allotransplantation ◽  
Traumatic Injuries ◽  
Composite Tissue ◽  
Form And Function ◽  
Composite Tissue Transplantation ◽  
And Function ◽  
Facial Composite

Facial composite tissue allotransplantation is an emerging field which offers the potentially restore facial form and function, even following the most severe traumatic injuries. This benefit must be carefully weighed against the need to lifelong immunosuppression, associated infection risks, and possible rejection. Patients must be carefully screened for medical and psychiatric issues prior to the procedure. However, in the well-selected patient, this procedure can be transformative. Uniformly, patients self-report a dramatic improvement post transplantation. In addition, return of sensation in the transplanted allograft occurs in 3–6 months, although return of motor function takes longer and remains incomplete. Ultimately, facial composite tissue transplantation is a powerful technique in the properly selected patient.

scholarly journals Nerve Allotransplantation as it Pertains to Composite Tissue Transplantation

Hand ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 239-244 ◽  
Author(s):  
Amy M. Moore ◽  
Wilson Z. Ray ◽  
Kristofer E. Chenard ◽  
Thomas Tung ◽  
Susan E. Mackinnon
Keyword(s):  
Nerve Regeneration ◽  
Solid Organ Transplantation ◽  
Tissue Transplantation ◽  
Large Animal ◽  
Solid Organ ◽  
Composite Tissue ◽  
Allograft Transplantation ◽  
Segmental Nerve ◽  
Composite Tissue Transplantation ◽  
And Function

Nerve allografts provide a temporary scaffold for host nerve regeneration and allow for the repair of significant segmental nerve injuries. From rodent, large animal, and nonhuman primate studies, as well as clinical experience, nerve allografts, with the use of immunosuppression, have the capacity to provide equal regeneration and function to that of an autograft. In contrast to solid organ transplantation and composite tissue transfers, nerve allograft transplantation requires only temporary immunosuppression. Furthermore, nerve allograft rejection is difficult to assess, as the nerves are surgically buried and are without an immediate functional endpoint to monitor. In this article, we review what we know about peripheral nerve allograft transplantation from three decades of experience and apply our current understanding of nerve regeneration to the emerging field of composite tissue transplantation.

Swine Hemi-Facial Composite Tissue Allotransplantation: A Model to Study Immune Rejection

2009 ◽  
Vol 153 (2) ◽  
pp. 268-273 ◽  
Author(s):  
Yur-Ren Kuo ◽  
Hsiang-Shun Shih ◽  
Chien-Chih Lin ◽  
Chung-Cheng Huang ◽  
Johnson Chia-Shen Yang ◽  
...  
Keyword(s):  
Immune Rejection ◽  
Composite Tissue Allotransplantation ◽  
Composite Tissue ◽  
Facial Composite

Vascularized composite allotransplantation

2021 ◽  
pp. 105-126
Author(s):  
Daniel Wilks ◽  
Simon Kay
Keyword(s):  
Lower Limb ◽  
Clinical Applications ◽  
Organ Allocation ◽  
Immunomodulatory Agents ◽  
Composite Tissue ◽  
Form And Function ◽  
Multiple Cell ◽  
And Function ◽  
Tissue Defects ◽  
Selection Of

Vascularized composite allotransplants contain the products of multiple cell lineages to reconstruct the form and function of complex, composite tissue defects. This chapter discusses the ethical principles and the immunology behind composite transplantation, including the selection of immunomodulatory agents and the immune basis and treatment of rejection. The principles of organ allocation and candidate preparation are presented prior to discussion of the clinical applications and outcomes of hand, face, abdominal wall, uterus, penis, and lower limb transplantation.

scholarly journals Composite tissue allotransplantation of the face: Decision analysis model

2007 ◽  
Vol 15 (3) ◽  
pp. 145-152 ◽  
Author(s):  
Sabrina Cugno ◽  
Sheila Sprague ◽  
Eric Duku ◽  
Achilleas Thoma
Keyword(s):  
Decision Analysis ◽  
Current Debate ◽  
Decision Analysis Model ◽  
Composite Tissue Allotransplantation ◽  
Face Transplantation ◽  
Facial Disfigurement ◽  
Composite Tissue ◽  
Life Years ◽  
The Face ◽  
Facial Composite

Background Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure. Study Design The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed. Results Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years. Conclusions The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.

scholarly journals A European perspective of the cost effectiveness of facial composite tissue allotransplantation

2019 ◽  
Vol 43 (3) ◽  
pp. 219-224 ◽  
Author(s):  
Tiffanie-Marie Borg ◽  
Seema Yalamanchili ◽  
Shadi Ghali ◽  
Simon Myers ◽  
Simon Holmes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
European Perspective ◽  
Composite Tissue Allotransplantation ◽  
Composite Tissue ◽  
The Cost ◽  
Facial Composite

scholarly journals Manipulating Stress Receptor Signaling to Enhance Immunosuppression and Prolong Survival of Vascularized Composite Tissue

2021 ◽  
Author(s):  
Minhyung Kim ◽  
Daniel Fisher ◽  
Paul Bogner ◽  
Umesh Sharma ◽  
Joseph Skitzki ◽  
...  
Keyword(s):  
Immunosuppressive Drugs ◽  
Body Parts ◽  
Composite Tissue Allotransplantation ◽  
Composite Tissue ◽  
Cytokines And Chemokines ◽  
Immune Contexture ◽  
Endothelial Adhesion Molecules ◽  
High Doses ◽  
Delayed Rejection ◽  
And Function

Abstract Vascularized composite tissue allotransplantation (VCA) can replace severely damaged body parts but the unavoidable toxicity of high doses of immunosuppressive drugs, such as tacrolimus, required results in significant morbidity. Here we tested whether we could suppress immune activity in a mouse model of VCA by mimicking the natural immune suppression generated by nervous system-induced signaling of adrenergic receptors (AR) by using a safe and well-studied β-AR agonist (terbutaline). Using wild-type and β2-AR-knockout (KO) mice, we found that increased β2-AR signaling results in delayed rejection in VCA recipients, even with subtherapeutic doses of tacrolimus, and this was associated with changes in immune contexture, expression of pro-inflammatory cytokines and chemokines, and function of endothelial adhesion molecules. We propose that β-AR agonists can be used safely to mimic the natural suppression of immune responses generated by adrenergic stress signaling and thereby reduce the dose needed of other more toxic immunosuppressive drugs.

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