In first major review of face transplants, scientists discover that majority have survived

The majority of the world’s first 50 face transplants have survived for at least a decade, researchers have discovered.

Doctors revisited dozens of patients who had the reconstructive surgery over the last decade in 11 countries. They found that 85 percent of the transplants survived for five years; and 74 percent for at least 10 years. Of the 50 transplants, six were rejected and another two needed to have the face re-transplanted.

Dr Pauliina Homsy, a co-author of the research led by Finland’s University of Helsinki, told The Independent on Wednesday that, initially, all face transplants were experimental and could only be done for patients “under very strict criteria.”

“What hasn’t changed is that it’s still done only for patients with no other options. Because, it’s a massively invasive surgery and with real risks related to surgery and the recovery [a] the lifetime of immunosuppression,” she said. “But, what has changed is that, actually, the patients are doing really well.”

The findings, published Wednesday in the journal JAMA Surgery, is the first time that the global long-term outcomes of the transplants has been studied.

“The reason why we want to know it is to try and convince people outside of our area who fund it and control the regulated permissions that actually this is a valid option for those patients [who] all the other reconstructive options have been exhausted for,” Homsy said.

A total of 50 face transplants have been performed since 2005 on 39 men and nine women, with most around the age of 35.

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The first face transplant in history was carried out in France in 2005 on a 46-year-old woman who had severe facial injuries from a dog bite. Isabelle Dinoire died of cancer at age 49 in 2016. The procedure, using the facial tissue of a dead donor, was replicated around the world.

One of the patients evaluated in the study is Robert Chelsea, 68, who became the first Black patient, and the oldest, to receive a full face transplant at Boston’s Brigham and Women’s Hospital in July 2019. A resident of Los Angeles, Chelsea had suffered burns over 60 percent of his body and face after his car was hit by a drunk driver in 2013. His transplant surgery lasted for 16 hours, involving a medical team of 45 people.

The process is long and hard, with the procedure lasting between 20 to 30 hours and then recovery going on for months. Patients are required to do exercises and the face starts moving between three to six months.

“It can be psychologically challenging to have a different face. So, all the patients are evaluated by psychologists, in a process that takes upwards of a year,” Homsy said.

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Many transplant patients end up having several surgeries.Some transplants don’t work and are rejected entirely. Sometimes, the same face needs to be re-transplanted.

Complications are largely related to immuno-supression drugs. But, the skin grafts can also be lost due to chronic rejection — a process that isn’t understood that well — where the facial tissue ages more rapidly than it should and blood vessels are blocked.

Immuno-suppression is damaging to the kidneys, and Homsy said that most face transplant patients end up with renal issues. A face transplant also predisposes the patient to skin cancer.

Those who received face transplants in the mid-2000s had the worst survival rates but operations have improved with each procedure and as medical techniques have advanced.

The study’s authors say the findings are encouraging and suggest transplants are an effective option for patients with severe facial defects.

“What is evident from our data is that the long-term results have improved significantly, as the international experience has taken place,” said Homsy. “So, the transplants that have been done in more recent years — they survive much better.”

Homsy said the next step is to improve the understanding of the pathological processes that lead to rejection.