Not so long ago, face transplants were considered futuristic medicine, but a new report shows these patients are better off years after their groundbreaking operations.
Six people who received full or partial face transplants have since had significant restoration of feeling and movement, along with an improved quality of life, surgeons say.
"From the data, you can see the clear benefits that our patients have obtained. It is important to keep in mind that there are no functional prosthetic options for face," said co-senior study author Dr. Bo Pomahac. He is chair in surgery and director of plastic surgery transplantation at Brigham and Women's Hospital in Boston.
"Face transplants have given these patients enough functionality to be able to socially reintegrate in a way that would not have been possible before," said Pomahac, who led the transplant teams.
The patients underwent face transplants after suffering severe facial injuries and have been followed for up to five years after surgery. They're the largest single group of face transplant patients in the United States.
The patients' facial movements improved greatly during and after the first year following surgery and reached an average of 60% of maximum function after five years, according to the surgical team.
The patients also had improvements in their ability to distinguish between hot and cold sensations on their skin, and to respond to pressure testing in the first year after surgery.
All but one of the patients reported improvements in quality of life, but there were no changes in the patients' depression scores, the findings showed.
Immunosuppressive medications, which patients must take after face transplantation, and related complications can take a mental toll on patients, the surgeons noted.
Each patient had between two and seven instances of acute transplant rejection that required treatment.
Immunosuppressive drugs can affect metabolism, but the patients did not develop new cases of diabetes or lipid disorders, and only one patient developed high blood pressure, which was diagnosed about two years after transplantation.
"In our previous studies, we reported that patients can speak better, eat better, breathe better. These aspects are important as well," Pomahac said in a hospital news release. "Here, we report that the return of motor function is in line with what you would see if you reconnected a severed nerve, and that sensory function appears to improve to near normal."
The paper describing the patients' outcomes was published May 29 in the New England Journal of Medicine.
"The first partial face transplant occurred in 2005, almost 50 years after the first kidney transplant was performed here at the Brigham," said co-senior study author Dr. Leonardo Riella, medical director of the Vascularized Composite Tissue Transplant Program.
"Therefore, it is important to realize how young the field of face transplantation really is. While we had used knowledge gained from other solid organ transplants, the face transplant is a complex structure that includes one of the most immunologically challenging tissues of all: the skin," Riella said.
"While we have witnessed great success so far, the challenges to minimize immunosuppression toxicity and reduce rejection rates continue," he explained.
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