Back to Search
Start Over
Accelerated chronic skin changes without allograft vasculopathy: A 10-year outcome report after face transplantation
- Source :
- Surgery. 167(6)
- Publication Year :
- 2019
-
Abstract
- Background Long-term outcomes after face transplantation are rarely reported in the scientific literature. Here we present outcome data of a partial face allograft recipient 10 years after transplantation. Methods Medical records were reviewed for functional and psychosocial outcomes as well as complications. Histopathologic analyses of autopsy tissues and characterization of skin immune cells were performed. Results The patient retained long-term motor and sensory function, though with a noticeable drop in sensory function after year 5. Social reintegration of the patient was marked by reconnection with his family and participation in public social activities. Immunosuppressive therapy consisted of tacrolimus (target levels 6–8 ng/mL after the first year), mycophenolate, and prednisone, while steroids were completely weaned between years 1 and 7. One acute cellular rejection episode of grade II or higher occurred on average per year and led to chronic skin changes (papillary dermal sclerosis with superficial hyalinization, epidermal thinning with loss of rete ridges, perieccrine fibrosis), but the allograft vessels, muscles, adipose tissue, and bone were spared. Allograft skin was characterized by increased number of CD4+ TNF-α/IL17A producing T-cells as compared with native skin. Long-term kidney function was maintained at 60 mL/min estimated glomerular filtration rate. Unfortunately, the preexisting hepatitis C virus infection with liver cirrhosis was resistant to 3 treatments with new direct-acting antivirals and eventually hepatocellular carcinoma developed, causing the patient’s death 10 years after transplantation. Conclusion This report suggests that face transplants can maintain their function for at least 10 years. Chronic skin changes can occur independently of allograft vasculopathy.
- Subjects :
- Male
medicine.medical_specialty
Cirrhosis
Carcinoma, Hepatocellular
T-Lymphocytes
Renal function
Autopsy
030230 surgery
03 medical and health sciences
0302 clinical medicine
Prednisone
Fibrosis
Medicine
Humans
Skin
business.industry
Tumor Necrosis Factor-alpha
Interleukin-17
Liver Neoplasms
Hepatitis C, Chronic
Middle Aged
medicine.disease
Allografts
Tacrolimus
Transplant Recipients
Surgery
Transplantation
030220 oncology & carcinogenesis
Hepatocellular carcinoma
CD4 Antigens
business
Immunosuppressive Agents
medicine.drug
Facial Transplantation
Follow-Up Studies
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 15327361
- Volume :
- 167
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....0310ebd5eac2f567a322b3c529256261