Risk Assessment of Immunosuppressive Therapy in Facial Transplantation

doi:10.1097/01.prs.0000270316.33293.ec

Paper

Risk Assessment of Immunosuppressive Therapy in Facial Transplantation

Published Sep 1, 2007 · D. Vasilic, R. Alloway, John H. Barker

Plastic and Reconstructive Surgery

Q1 SJR score

42

Citations

0

Influential Citations

Full text

Semantic Scholar

Abstract

Background: Immunosuppression-related risks are foremost among ethical concerns regarding facial transplantation. However, previous risk estimates are inaccurate and misleading, because they are based on data from studies using different immunosuppression regimens, health status of the transplant recipients, tissue composition, and antigenicity. This review provides a comprehensive risk assessment for facial transplantation based on comparable data of immunosuppression, recipient health status, and composition and antigenicity of the transplanted tissue. Methods: The risk estimates for face transplantation presented here are based on data reported in clinical kidney (10-year experience) and hand transplantation (5-year experience) studies using tacrolimus/mycophenolate mofetil/corticosteroid therapy. Mitigating factors including ease of rejection diagnosis, rejection reversibility, infection prophylaxis, patient selection, and viral serologic status are taken into account. Results: Estimated risks include acute rejection (10 to 70 percent incidence), acute rejection reversibility (approximating 100 percent with corticosteroid therapy alone), chronic rejection (<10 percent over 5 years), cytomegalovirus disease (1 to 15 percent), diabetes (5 to 15 percent), hypertension (5 to 10 percent), and renal failure (<5 percent). Conclusions: A review of these data indicates that previously reported estimates of immunosuppression-related risks are outdated and therefore should no longer be used. These updated risk estimates should be used by facial transplant teams, institutional review boards, and potential recipients when considering the immunologic risks associated with facial transplantation.

Literature Review

Study Snapshot

Key takeawayThis review provides updated risk estimates for facial transplantation, based on comparable data from clinical kidney and hand transplantation studies, to replace outdated estimates.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

Sign up to use Study Snapshot

Consensus is limited without an account. Create an account or sign in to get more searches and use the Study Snapshot.

Create an account

Paper

Risk Assessment of Immunosuppressive Therapy in Facial Transplantation

Sign up to use Study Snapshot

References

The International Registry on Hand and Composite Tissue Transplantation

Hand transplantation is a complex procedure, with success based on patient compliance and careful evaluation before and after transplantation.

Psychosocial Implications of Disfigurement and the Future of Human Face Transplantation

Face transplantation can potentially relieve the psychosocial consequences of facial disfiguration, warranting further research and development in the field.

Composite tissue allotransplantation of the hand and face: a new frontier in transplant and reconstructive surgery

Composite tissue allotransplantation has become a clinical reality for hand and facial reconstruction, with advances in immunotherapy and surgical methods making it a promising treatment for severe facial disfigurement.

First human face allograft: early report

Composite tissue transplantation shows potential in facial reconstruction, with successful appearance, sensitivity, and patient acceptance after 4 months.

On the ethics of composite tissue allotransplantation (facial transplantation).

Facial transplantation is a complex, ethical procedure that aims to improve appearance and function for patients with severe facial deformities, but not for life-saving purposes.

The International Registry on Hand and Composite Tissue Transplantation

Hand transplantation is a complex procedure, with success based on patient compliance and careful evaluation before and after transplantation.

Citations

The Impact of Alloantibodies on Clinical VCA Outcomes and the Need for Immune Tolerance

Novel tolerance-inducing strategies, such as anti-CD3 immunotoxins, could significantly improve vascularized composite allotransplantation outcomes and recipient quality of life.

Maxillary and Mandibular Healing after Facial Allotransplantation

Le Fort osteotomy shows inferior healing in facial transplantation compared to nontransplant patients, while mandible healing is successful due to high density of rich cancellous bone.

Manipulating adrenergic stress receptor signalling to enhance immunosuppression and prolong survival of vascularized composite tissue transplants

A safe 2adrenergic receptor agonist can safely mimic natural immune responses and reduce the dose needed for toxic immunosuppressive drugs like tacrolimus in vascularized composite tissue transplantation.

A Comparison of Immunosuppression Regimens in Hand, Face, and Kidney Transplantation.

VCA and kidney recipients receive comparable MMF/prednisone doses and most VCA recipients are treated with TTTL similar to kidney recipients at longer follow-up intervals.

In Experimental Hand Transplantation, Whose Views About Outcomes Should Matter Most?

Patient-subjects' views should be the most important factor in experimental hand transplantation, with shared decision-making and respect for their right to stop being enrolled in research.

Application of a New Paradigm for Cytomegalovirus Disease Prevention in Mayo Clinic's First Face Transplant

An individualized hybrid approach using valganciclovir prophylaxis and surveillance guided by viral and immunologic markers effectively prevents cytomegalovirus disease after face transplantation.

Psychological and Psychosocial Aspects of Face Transplantation

Face transplantation shows promise for improved social integration, despite risks and potential graft loss.

Are We Ready for a Human Head Transplant? The Obstacles That Must Be Overcome

Human body-to-head transplantation faces complex ethical, surgical, immunological, and psychosocial challenges, and lacks adequate experimental foundation.

Face transplantation: Complications, implications, and an update for the oncologic surgeon

Face transplantation is a safe and preferred reconstructive option for severe facial defects, improving patient's quality of life, but its applicability to post-oncologic resection remains guarded due to long-term outcomes.