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Review
. 2007 Sep;120(3):657-668.
doi: 10.1097/01.prs.0000270316.33293.ec.

Risk assessment of immunosuppressive therapy in facial transplantation

Dalibor Vasilic  1 , Rita R Alloway, John H Barker, Allen Furr, Rachael Ashcroft, Joseph C Banis Jr, Moshe Kon, E Steve Woodle
Affiliations
Review

Risk assessment of immunosuppressive therapy in facial transplantation

Dalibor Vasilic et al. Plast Reconstr Surg. 2007 Sep.

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Conclusions: A review of these data indicates that previously reported estimates of immunosuppression-related risks are outdated and therefore should no longer be used.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.

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References

    1. Devauchelle, B., Badet, L., Lengele, B., et al. First human face allograft: Early report. Lancet 368: 203, 2006.
    1. Wiggins, O. P., Barker, J. H., Martinez, S., et al. On the ethics of facial transplantation research. Am. J. Bioeth. 4: 1, 2004.
    1. Agich, G. J., and Siemionow, M. Facing the ethical questions in facial transplantation. Am. J. Bioeth. 4: 25, 2004.
    1. Ankeny, R. A., and Kerridge, I. On not taking objective risk assessments at face value. Am. J. Bioeth. 4: 35, 2004.
    1. Banis, J. C., Barker, J. H., Cunningham, M., et al. Response to selected commentaries on the AJOB target article “On the ethics of facial transplantation research.” Am. J. Bioeth. 4: W23, 2004.

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