• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Face Transplants Divide Scientists Risks Are Great and Results of Surgery Remain Uncertain

Posted on: Friday, 2 December 2005, 12:00 CST

By Lawrence K. Altman

Face transplants are among the most disputed frontiers in transplantation science because they are so risky and because no one can predict what a patient who receives a transplant will look like after the surgery.

A partial face transplant performed in France this week represents the first foray into this much-debated realm of medicine. A number of surgical teams in the United States, France and the Netherlands have announced plans to perform face transplants when there is an appropriate match between a donor and a patient. But none are known to have performed the procedure.

The recipient of the transplant was a 38-year-old woman who was severely disfigured after she was attacked by a dog in May, said the surgeon, Jean-Michel Dubernard of Lyon. The operation was carried out in Amiens on Sunday.

In a brief telephone interview Wednesday, Dubernard said the two surgical teams grafted a nose, lips and chin from a donor who had been declared brain- dead onto the woman's face. Hospital officials said the woman who received the transplant did not wish to be identified. Ethics committees in France and England have rejected proposals to perform full face transplants until more research is done. The committees were concerned about the unknown risks of the long-term use of large doses of immunosuppressive drugs for a procedure that does not save lives. The aim of face transplants is to improve the quality of life for patients who have suffered severe injuries from burns, accidents and shootings, for example.

The French committee did approve partial face transplants of the type performed on the woman in Amiens. But the committee cautioned in a report last year that even a partial transplant the mouth and the nose, for example was "high-risk experimentation."

In the United States, an institutional review board that oversees the safety of human experiments at the Cleveland Clinic last year became the first such body to approve a full face transplant.

Full face transplants and partial ones involve the transfer of attached muscles, blood vessels, nerves and other tissues. The tissues are needed to help restore an acceptable appearance for the recipient.

Among the risks of either type are the chance that the graft will be rejected, leaving a patient in a worse condition than before the operation, the development of cancer from the immunity suppressing drugs given to prevent organ rejection and the chance that a patient will suffer major psychological problems in adjusting to a new appearance.

Dubernard said the patient was transferred Tuesday from Amiens to the Edouard Herriot Hospital in Lyon, where Dubernard works, for long-term monitoring of the immunosuppressive therapy that she will need to prevent rejection of the new partial face.

The transfer was in accord with a scientific blueprint that Dubernard said he and Bernard Devauchelle of Amiens agreed on before the operation.

He described Devauchelle's team as "very well trained for this type of surgery."

In 1998, Dubernard headed the team that performed the first hand- forearm transplant. He is also a politician and member of the French Parliament.

Outside experts said that it was difficult to know whether the partial transplant was as difficult to perform as a full face transplant. For example, it is not known how badly injured the woman was or how much of the donor's face and underlying muscle, blood vessels and tissue were transplanted.

Also, the experts said that they could not determine how well the French team had informed and prepared the woman psychologically for the transplant.

The relatively short interval of about six months between the dog bite and the surgery also raised questions in the minds of some experts about what, if any, efforts had been made to perform reconstructive surgery before the transplant. "The major question is: What were the indications" for the transplant, said Maria Siemionow, a surgeon at the Cleveland Clinic who plans to perform a full face transplant.

Questions about the timing of the French surgery are relevant because the first patient to receive a hand transplant, Clint Hallam, did not follow his prescribed anti-rejection therapy. He had his transplanted hand amputated in 2001, three years after he received it.

Laurent Lantieri, a surgeon who was not directly connected with the French woman's surgery but has reviewed some of her records, said he was puzzled about why she was put on the list for a face transplant in June or July, so soon after she received her injuries.

Lantieri said in an interview that he had reviewed a summary of the woman's medical record and examined a photograph of her severely damaged face. The type of injury seemed consistent with proposals to do a partial facial transplant, he said.

"She had very strong psychological problems," Lantieri said. "I said I would not go further if I did not have more examinations by additional psychiatrists to know that she would be able to pursue lifelong immunosuppression therapy."

Lantieri said he believed that Dubernard "wanted to be first" to do a face transplant, as he had done a hand transplant.

Dubernard said his team planned to do another transplant of bone marrow on the woman while she was in the hospital in Lyon. Although bone marrow transplants are a standard treatment for some conditions, in this case the hope would be that it would increase the patient's tolerance to a graft.

*

Craig Smith contributed reporting from Paris.

Source: International Herald Tribune

More News in this Category