The Experts below are selected from a list of 2919 Experts worldwide ranked by ideXlab platform
Bohdan Pomahac - One of the best experts on this subject based on the ideXlab platform.
-
Recognizing Emotional Expression as an Outcome Measure After Face Transplant.
JAMA network open, 2020Co-Authors: Miguel I. Dorante, Branislav Kollar, Doha Obed, Valentin Haug, Sebastian Fischer, Bohdan PomahacAbstract:Importance Limited quantitative data exist on the restoration of nonverbal communication via facial emotional expression after Face Transplant. Objective and noninvasive methods for measuring outcomes and tracking rehabilitation after Face Transplant are lacking. Objective To measure emotional expression as an indicator of functional outcomes and rehabilitation after Face Transplant via objective, noninvasive, and nonobtrusive software-based video analysis. Design, Setting, and Participants This single-center case-control study analyzed videos with commercially available video analysis software capable of detecting emotional expression. The study participants were 6 patients who underwent Face Transplant at Brigham and Women’s Hospital between April 2009 and March 2014. They were matched by age, race/ethnicity, culture, and sex to 6 healthy controls with no prior facial surgical procedures. Participants were asked to perform either emotional expressions (direct evaluation) or standardized facial movements (indirect evaluation). Videos were obtained in a clinical setting, except for direct evaluation videos of 3 patients that were recorded at the patients’ residences. Data analysis was performed from June 2018 to November 2018. Main Outcomes and Measures The possibility of detecting the emotional expressions of happiness, sadness, anger, fear, surprise, and disgust was evaluated using intensity score values between 0 and 1, representing expressions that are absent or fully present, respectively. Results Six patients underwent Face Transplant (4 men; mean [SD] age, 42 [14] years). Four underwent full Face Transplants, and 2 underwent partial Face Transplants of the middle and lower two-thirds of the Face. In healthy controls, happiness was the only emotion reliably recognized in both indirect (mean [SD] intensity score, 0.92 [0.05]) and direct (mean [SD] intensity score, 0.91 [0.04]) evaluation. Indirect evaluation showed that expression of happiness significantly improved 1 year after Transplant (0.04 point per year; 95% CI, 0.02 to 0.06 point per year;P = .002). Expression of happiness was restored to a mean of 43% (range, 14% to 75%) of that of healthy controls after Face Transplant. The expression of sadness showed a significant change only during the first year after Transplant (−0.53 point per year; 95% CI, −0.82 to −0.24 point per year;P = .005). All other emotions were detectable with no significant change after Transplant. Nearly all emotions were detectable in long-term direct evaluation of 3 patients, with expression of happiness restored to a mean of 26% (range, 5% to 59%) of that of healthy controls. Conclusions and Relevance Partial restoration of facial emotional expression is possible after Face Transplant. Video analysis software may provide useful clinical information and aid rehabilitation after Face Transplant.
-
Increased levels of circulating MMP3 correlate with severe rejection in Face Transplantation
Scientific Reports, 2018Co-Authors: Branislav Kollar, S. Tasigiorgos, Christine G Lian, Thiago J. Borges, George F. Murphy, Andrey Shubin, Simon T. Dillon, Xuesong Gu, Iris Wyrobnik, Bohdan PomahacAbstract:Face Transplantation is a viable treatment option for carefully selected patients with devastating injuries to the Face. However, acute rejection episodes occur in more than 80% of recipients in the first postoperative year. Unfortunately, neither a correlation between histological grades of rejection and anti-rejection treatment nor systemic surrogate markers of rejection in Face Transplantation are established in clinical routine. Therefore, we utilized next generation aptamer-based SOMAscan proteomics platform for non-invasive rejection biomarker discovery. Longitudinal serum samples from Face Transplant recipients with long-term follow-up were included in this study. From the 1,310 proteins analyzed by SOMAscan, a 5-protein signature (MMP3, ACY1, IL1R2, SERPINA4, CPB2) was able to discriminate severe rejection from both no-rejection and nonsevere rejection samples. Technical validation on ELISA platform showed high correlation with the SOMAscan data for the MMP3 protein (r_s = 0.99). Additionally, MMP3 levels were significantly increased during severe rejection as compared to no-rejection (p = 0.0009) and nonsevere rejection (p = 0.0173) episodes. Pathway analyses revealed significant activation of the metallopeptidase activity during severe Face Transplant rejection. This pilot study demonstrates the feasibility of SOMAscan to identify non-invasive candidate biomarkers of rejection in Face Transplantation. Further validation in a larger independent patient cohort is needed.
-
facial restoration by Transplantation
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, 2018Co-Authors: Branislav Kollar, Bohdan PomahacAbstract:Abstract Hundred years ago, Sir Harold Gillies laid a foundation to the modern plastic surgery trying to reconstruct facial defects of severely disfigured soldiers of World War I. Some years later, Joseph Murray experimented with rejection of skin grafts aimed for treatment of burned patients who sustained their injuries on battlefields of World War II. In 1954, the acquired expertise and intensive research allowed him to perform the first successful kidney Transplantation in the world at Peter Bent Brigham Hospital in Boston. For his achievements in organ Transplantation he was awarded Nobel Prize in 1990. The Face Transplantation appears to be a natural evolution of the work of these two extraordinary plastic surgeons. The first case of partial Face Transplant from 2005 in France revealed the world that facial restoration by Transplantation is superior to conventional reconstruction methods. Since 2009, our team has performed 7 cases of Face Transplantation at Brigham and Women's Hospital, which is to our best knowledge the largest living single center Face Transplant cohort in the world. In this article, we want to reflect on the experience with Face Transplantation at our institution from the past years. We aim to briefly review the key points of the know-how which was given to us from the care of these unique patients.
-
Psychological Outcomes in Face Transplant Recipients: A Literature Review
Current Surgery Reports, 2017Co-Authors: Marie-christine Nizzi, S. Tasigiorgos, M. Turk, C. Moroni, Ericka M. Bueno, Bohdan PomahacAbstract:To synthesize findings regarding the psychological outcomes of Face Transplantation. Thirty-seven Face Transplants have been done since the world’s debutant case was featured in 2005. In spite of impressive clinical success, little has been achieved to date in terms of understanding the mental health, quality of life, and psychosocial outcomes of Face Transplant recipients. We conducted a literature search in PubMed for studies reporting any psychosocial measure in Face Transplant recipients, between 2005 and 2017. We identified 20 articles: 11 articles reported qualitative evaluation of outcomes, and nine articles used quantitative measures. Recipients were generally satisfied with the aesthetic result of the procedure, succeeded in integrating the new Face into their sense of self within the first few weeks to months post-Transplant, and experienced a major and lasting improvement in social integration for years after the Transplant. We recommend a systematic reporting of detailed psychosocial evaluations through the use of validated measures administered at regular intervals, to allow for the emergence of a population-level assessment of the psychosocial outcomes of Face Transplantation.
-
Reflections on a Decade of Face Transplantation
Annals of surgery, 2017Co-Authors: Giorgio Giatsidis, Indranil Sinha, Bohdan PomahacAbstract:On November 27, 2005, Isabelle Dinoire underwent the world's first partial Face Transplant in Amiens (France) after a dog attack had left her Face severely disfigured. The abrupt surgical leap found the medical community and society unprepared to deal with the scientific, ethical, and societal impli
Maria Siemionow - One of the best experts on this subject based on the ideXlab platform.
-
characterization of Face Transplant candidates evaluated at cleveland clinic and algorithm to maximize efficacy of screening process
Annals of Plastic Surgery, 2020Co-Authors: Rebecca Knackstedt, Maria Siemionow, Frank A Papay, Risal Djohan, Debra Priebe, Brian R GastmanAbstract:Introduction As a high-volume referral center for facial Transplantation, we have learned significantly from the screening, evaluation, and enrollment process. This report analyzes our algorithm for the assessment of potential Face Transplant candidates referred to our institution. Methods After institutional review board approval in 2004, a prospectively maintained database was created for patients who were referred Face Transplant. Records were reviewed for the nature of tissue defect, functional deficit, surgical and medical history, and expert recommendations.Our algorithm begins with a review of a patient's file with a focus on institutional review board criteria. After screening, a phone interview is conducted, and Transplantation is discussed. Patients are presented to the team to analyze the medical, psychiatric, and surgical history; support network; and geographic location. Eligible patients are invited for an in-person evaluation, and the case is reviewed again with the team. If approved, the patient can provide consent for Transplantation. Results More than 200 patients were referred for Transplant evaluation at the Cleveland Clinic from 2004 to 2016. Sixty were eligible for further evaluation for Face Transplantation based on preliminary screening. Thirteen (6.5% of original cohort) were invited for in-person evaluation and physical examination. Five (2.5% of original cohort, 38.4% invited cohort) of these 13 patients underwent Face Transplantation, of whom, 3 (1.5% of original cohort, 23.1% invited cohort) underwent Face Transplantation at our institution. All 3 patients who were ultimately Transplanted were referred by a physician. Discussion As the availability of public information on Face Transplant increases, it is likely that an increase in self-referral for Face Transplantation will occur. Thus, it is critical that institutions adopt a systematic approach to triage in order to identify appropriate patients. Our algorithm allowed for a high enrollment and Transplantation ratio to save patient and institution time and resources. This could be easily adopted by other institutions to save time, money, and resources.
-
The past the present and the future of Face Transplantation.
Current opinion in organ transplantation, 2020Co-Authors: Maria SiemionowAbstract:PURPOSE OF REVIEW Face Transplantation represents vascularized composite alloTransplantation (VCA) organ and became one of the most rewarding reconstructive options for severely disfigured patients. This review summarizes the past, current and future challenges of Face Transplantation, based on our experience and literature reports. RECENT FINDINGS In 2005, first partial Face Transplantation was reported by French team. In 2008, we have performed the US first near-total Face Transplantation. Currently, more than 40 Face Transplant cases were reported worldwide. Based on the outcomes of our three patients and the literature reports, Face Transplantation improved aesthetics, function and the quality of life of Face Transplant patients. However, there are still many challenges encountered including the side effects of immunosuppressive protocols, the psychological and social problems as well as the financial challenges which need to be address in the near future to maintain Face Transplantation in the armamentarium of reconstructive surgery. SUMMARY Currently, feasibility of Face Transplantation was confirmed; however, the life-long immunosuppressive protocols bearing serious side effects are still required to prevent Face rejection. Thus, for the future of Face and other VCA, novel approaches of cell-based therapies or engineered scaffolds should be developed to make Face Transplantation safer.
-
The decade of Face Transplant outcomes
Journal of Materials Science: Materials in Medicine, 2017Co-Authors: Maria SiemionowAbstract:At the 10th year anniversary of the first Face Transplantation, 37 patients worldwide, were the recipients of Faces coming from human donors. Five patients died due to complications, noncompliance with immunosuppressive medications and development of cancer. Despite the initial debates and ethical concerns, Face Transplantation became a clinical reality with satisfactory functional outcomes. The areas of controversy still include the impact of life-long immunosuppression on otherwise healthy patients as well as the selection process of Face Transplant candidates. Other concerns include financial support for this new generation of Transplants as well as social re-integration and patients return to work after Face Transplantation. Based on over 20 years of research experience in the field of vascularized composite alloTransplantation (VCA), and clinical experience as a leading surgeon of the US first Face Transplantation, this review will summarize the well—known facts as well as unexpected outcomes and challenges of Face Transplantation. Graphical Abstract
-
Full Face Transplant Model in Rats
Plastic and Reconstructive Surgery, 2014Co-Authors: Yalcin Kulahci, Maria SiemionowAbstract:In this chapter authors present composite full Face Transplantation model in rats based on the bilateral common carotid arteries and external jugular veins. It is the first rodent model of full Face Transplantation which introduced to literature in 2003 by Ulusal et al. Along with its surgical details as an new composite tissue Transplantation, developers also confirmed the feasibility of full Face allograft Transplantation across MHC barriers in the rodent model for the first time in the literature. Transplants were performed between semi-allogeneic LBN donors and Lewis recipients and long term survival without sings of rejection was achieved up to 200 days under low dose cyclosporine A monotherapy.
-
a four year pathology review of the near total Face Transplant
American Journal of Transplantation, 2013Co-Authors: Wilma F Bergfeld, Aleksandra Klimczak, Jason Stratton, Maria SiemionowAbstract:In December of 2008, our institution performed a near total Face Transplant. The patient was monitored for signs of rejection assessed by paired skin and mucosa biopsies. The results of histological review of 120 biopsies collected during the first 4 years postTransplant are discussed. All biopsies were stained with hematoxylin and eosin, periodic acid-Schiff, immunohistochemical and TUNEL assays and graded using the Banff 2007 classification. Grade III rejection was diagnosed clinically at weeks 45 and 66, postTransplant; week 45 was determined as folliculitis while the erythema episode at week 66 confirmed an acute rejection (AR) that required hospitalization. The mucosa frequently showed interFace inflammation without clinical signs of rejection and was not present in skin biopsies. In all, 34 of the 45 mucosal biopsies (75%) showed these interFace changes. Clinical symptoms concurred with skin pathology in two grade III rejections. The mucosa showed histologic signs of rejection more frequently, which may indicate: increased mucosal sensitivity to rejection, a different type or subtype of AR that is specific to the mucosa, or a nonspecific process such as a drug effect. With more data and world experience, the diagnosis of Face Transplant rejection will be better defined and the Banff classification enhanced.
Eduardo D. Rodriguez - One of the best experts on this subject based on the ideXlab platform.
-
perceptions of quality of life among Face Transplant recipients a qualitative content analysis
Plastic and reconstructive surgery. Global open, 2020Co-Authors: Jason A Greenfield, Laura L. Kimberly, Allyson R. Alfonso, Elie P. Ramly, Zoe P Berman, Olive Lee, Gustave K Diep, Eduardo D. RodriguezAbstract:The aim of facial Transplantation (FT) was to enhance quality of life (QoL) for individuals living with severe facial disfigurement. Yet QoL has proved challenging to assess, as the field lacks a unified approach for incorporating FT recipients' perspectives into meaningful QoL measures. In this study, we review FT recipients' self-reported QoL through a qualitative analysis of publicly available postTransplant interviews to identify the aspects of QoL they report as meaningful. Methods A conventional qualitative content analysis was conducted through a comprehensive review of publicly available interviews with FT recipients. Data sources included English language audio, video, and online print interviews from 2008 to 2019. Recipient interview data were obtained for both partial and full FT recipients located in North America through Google and YouTube searches. Audio and video interviews were transcribed, and an inductive content analysis was used to develop and apply a coding scheme to all interview transcripts. Codes were subsequently grouped into categories and interpreted into themes. Results In total, 81 interviews representing 12 North American, English-speaking Face Transplant recipients were collected from internet sources, of which 74 interviews remained after exclusion criteria were applied. Three themes emerged representing the dimensions of QoL emphasized by FT recipients: (1) reconstitution and re-embodiment of physical/corporeal selfhood, (2) integrity of cognitive/emotional selfhood, and (3) social selfhood and the importance of social integration. Conclusions This study provides an insight into North American FT recipients' experiences, values, and goals and illuminates critical aspects of QoL that are meaningful to this unique patient population, which may not be fully captured by currently available assessment tools. The themes developed in this study link Facets of QoL to the overall significance of embodied selfhood among FT recipients and will help inform the future development of FT-specific patient-reported QoL outcome measures.
-
enhancing Face Transplant outcomes fundamental principles of facial allograft revision
Plastic and reconstructive surgery. Global open, 2020Co-Authors: Gustave K Diep, Elie P. Ramly, Allyson R. Alfonso, Zoe P Berman, Eduardo D. RodriguezAbstract:Facial Transplantation (FT) has become a feasible reconstructive solution for patients with devastating facial injuries. Secondary revisions to optimize functional and aesthetic outcomes are to be expected, yet the optimal timing and approach remain to be determined. The purpose of this study was to analyze all facial allograft revisions reported to date, including the senior author's experience with 3 FTs. Methods A literature review was performed, with 2 reviewers independently conducting title and abstract screening, followed by a full-text review. All articles mentioning FT revision surgeries were evaluated. The medical records of the senior author's 3 FT recipients were additionally reviewed. Results Initially, 721 articles were captured and 37 were included in the final analysis. Thirty-two FTs were reported to have involved postTransplant allograft revisions, with FT recipients undergoing a mean of 4.8 ± 4.6 revision procedures. The mean duration between FT and the first revision procedure was 149 ± 179 days. A wide spectrum of revisions was identified and categorized as involving the soft tissues, craniofacial skeleton, dentition, oronasal cavity, salivary glands, facial nerve, or ocular region. In the senior author's experience, when indicated, postTransplant occlusal changes and integrity of the donor-recipient intraoral interFace were successfully addressed with secondary procedures without allograft compromise or loss. Conclusions The worldwide experience shows that secondary procedures are nearly ubiquitous after FT and can be safely performed at various timepoints. The authors thereby establish 5 distinct categories of facial allograft revisions and define 7 critical principles to optimize postTransplant procedures.
-
Vascularised Composite AlloTransplantation (Face Transplantation)
Atlas of Operative Maxillofacial Trauma Surgery, 2020Co-Authors: Michael Sosin, Nicholas D. Brownstone, Eduardo D. RodriguezAbstract:The purpose of this chapter is to introduce Face Transplantation, discuss case selection, review the considerations in allograft design and preoperative planning, describe a stepwise process in executing a full-Face Transplant based on our experience and review some of the complications and outcomes.
-
total eyelid Transplantation in a Face Transplant analysis of postoperative periorbital function
Journal of Surgical Research, 2020Co-Authors: Maria I Grigos, William J. Rifkin, Rami S. Kantar, Etoile Leblanc, Rodrigo J Diazsiso, Jason A Greenfield, Eduardo D. RodriguezAbstract:Abstract Background Prolonged impairment of protective ocular functions can compromise vision and lead to blindness if uncorrected. Several facial Transplants have incorporated periorbital structures with variable eyelid preservation, but objective assessment of post-Transplant periorbital function has been limited. Materials and methods Kinematic data were collected from a full-Face recipient that included the fist total eyelid Transplantation at 5 separate pre-Transplant (PRE) and post-Transplant time points (T1-T4). Using optical facial tracking, eyelid movements were tracked during involuntary blinking and compared with controls. Results There was significant improvement in right eye aperture from PRE to T1 (β = 5.54, P Conclusions Application of a novel method for assessing functional eyelid recovery using facial tracking technology to the first total eyelid Transplantation in the setting of a full facial Transplant shows clear functional improvement after Transplantation and suggests revisions can be performed safely to optimize aesthetic outcomes without permanent negative functional impact.
-
Magnetic Resonance Imaging Volumetry of Facial Muscles in a Face Transplant Recipient.
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Rami S. Kantar, William J. Rifkin, J. Rodrigo Diaz-siso, Nicole Wake, Allyson R. Alfonso, Elie P. Ramly, Eduardo D. RodriguezAbstract:Face Transplantation has evolved into a viable reconstructive option for patients with extensive facial disfigurement. Because the first Face Transplant procedure was described in 2005, the safety and feasibility of the procedure have been validated, and the focus of the field has shifted toward refining functional and esthetic outcomes. Recovery of muscle function following facial Transplantation is critical to achieving optimal facial function and restoring facial expression. Assessment of facial muscle function in Face Transplant recipients has traditionally relied on clinical evaluation. In this study, we describe longitudinal changes in facial muscle volumes captured through quantitative magnetic resonance imaging in a Face Transplant recipient and compare these findings with functional outcomes evaluated through clinical assessment.
Ericka M. Bueno - One of the best experts on this subject based on the ideXlab platform.
-
Psychological Outcomes in Face Transplant Recipients: A Literature Review
Current Surgery Reports, 2017Co-Authors: Marie-christine Nizzi, S. Tasigiorgos, M. Turk, C. Moroni, Ericka M. Bueno, Bohdan PomahacAbstract:To synthesize findings regarding the psychological outcomes of Face Transplantation. Thirty-seven Face Transplants have been done since the world’s debutant case was featured in 2005. In spite of impressive clinical success, little has been achieved to date in terms of understanding the mental health, quality of life, and psychosocial outcomes of Face Transplant recipients. We conducted a literature search in PubMed for studies reporting any psychosocial measure in Face Transplant recipients, between 2005 and 2017. We identified 20 articles: 11 articles reported qualitative evaluation of outcomes, and nine articles used quantitative measures. Recipients were generally satisfied with the aesthetic result of the procedure, succeeded in integrating the new Face into their sense of self within the first few weeks to months post-Transplant, and experienced a major and lasting improvement in social integration for years after the Transplant. We recommend a systematic reporting of detailed psychosocial evaluations through the use of validated measures administered at regular intervals, to allow for the emergence of a population-level assessment of the psychosocial outcomes of Face Transplantation.
-
noninvasive monitoring of immune rejection in Face Transplant recipients
Plastic and Reconstructive Surgery, 2015Co-Authors: Maximilian Kueckelhaus, Sebastian Fischer, Nicole Wake, Ericka M. Bueno, Frank J Rybicki, Kanako K Kumamaru, Amir Imanzadeh, Muayyad Alhefzi, Marie Gerhardherman, Bohdan PomahacAbstract:Background:Chronic rejection leading to allograft loss remains a significant concern after facial alloTransplantation. Chronic rejection may occur without clinical signs or symptoms. The current means of monitoring is histologic analyses of allograft biopsy specimens, which is both invasive and impr
-
facial Transplantation worth the risks a look at evolution of indications over the last decade
Current Opinion in Organ Transplantation, 2015Co-Authors: Luccie Wo, Ericka M. Bueno, Bohdan PomahacAbstract:Purpose of reviewThe first Face Transplant was performed 10 years ago by Dubernard and his team in France. Since then, surgeons have continued to push the frontiers of vascularized composite alloTransplantation and broaden the indications for Face Transplantation. In this review, we summarize some o
-
Biomarker evaluation of Face Transplant rejection: association of donor T cells with target cell injury
Modern Pathology, 2014Co-Authors: Christine G Lian, Ericka M. Bueno, Scott R Granter, Alvaro C Laga, Arturo P Saavedra, Qian Zhan, Anil Chandraker, Stefan G Tullius, Joseph S Susa, Bohdan PomahacAbstract:This series of 113 sequential biopsies of full facial Transplants provides findings of potential translational significance as well as biological insights that could prompt reexamination of conventional paradigms of effector pathways in skin allograft rejection. Serial biopsies before, during, and after rejection episodes were evaluated for clinicopathological assessment that in selected cases included specific biomarkers for donor- versus -recipient T cells. Histologic evidence of rejection included lymphocyte-associated injury to epidermal rete ridges, follicular infundibula, and dermal microvessels. Surprisingly, during active rejection, immune cells spatially associated with target cell injury consisted abundantly or predominantly of lymphocytes of donor origin with an immunophenotype typical of the resident memory T-cell subset. Current dogma assumes that skin allograft rejection is mediated by recipient T cells that attack epidermal targets, and the association of donor T cells with sites of target cell injury raises questions regarding the potential complexity of immune cell interactions in the rejection process. A more histopathologically refined and immune-based biomarker approach to assessment of rejection of facial Transplants is now indicated.
-
biomarker evaluation of Face Transplant rejection association of donor t cells with target cell injury
Modern Pathology, 2014Co-Authors: Christine G Lian, Ericka M. Bueno, Scott R Granter, Alvaro C Laga, Arturo P Saavedra, William M Lin, Joseph Susa, Qian Zhan, Anil Chandraker, Stefan G TulliusAbstract:Biomarker evaluation of Face Transplant rejection: association of donor T cells with target cell injury
Kathy L. Coffman - One of the best experts on this subject based on the ideXlab platform.
-
Psychological and Psychosocial Aspects of Face Transplantation
Psychosocial Care of End-Stage Organ Disease and Transplant Patients, 2018Co-Authors: Kathy L. CoffmanAbstract:The first Face Transplant was performed in 2005 raising ethical and psychological issues only conjectured about until then. The number of Face Transplant recipients has continued to grow worldwide, to 39 known by the end of 2017. Unfortunately, the data being gathered about psychological outcomes tends to be descriptive rather than through systematic use of standardized rating instruments. Despite the data quality, there is reason for optimism regarding improved social integration for Face Transplant recipients. The risk of cancers and specter of chronic rejection with possible loss of the graft reflect the downside of Face Transplantation, as with solid organ grafts. However, the loss of the Face once restored or even part of the graft is a devastating outcome, experienced by a few recipients at this point. Overall there is reason to be optimistic about the psychological adaptation of FT recipients.
-
Psychiatric evaluation of the Face Transplant candidate.
Current opinion in organ transplantation, 2015Co-Authors: Kathy L. CoffmanAbstract:PURPOSE OF REVIEW There have now been a total of 32 Face Transplants done in the world since the first in Amien, France, in 2005. This procedure is moving from being considered experimental to being considered an accepted option for reconstruction in cases of severe facial disfigurement. RECENT FINDINGS There have been three published reports of prospective quantitative assessments of facial Transplant candidates related to psychological outcomes with Face Transplant recipients. Various instruments have been used in assessment, including the Beck Depression Inventory, Patient Health Questionnaire-9 (PHQ-9), and Center for Epidemiologic Studies Depression Scale for rating depressive symptoms. Quality-of-life instruments used have included the Short Form-12, the Short Form-36, the Euro-QOL-5D (EQ-5D), the WHO Quality of Life rating scale (WHO-BREF), and the Psychosocial Adjustment to Illness Scale-Self-Report. SUMMARY There have been three deaths in the first 32 cases of facial Transplantation (9.4%), two cases of post-Transplant lymphoproliferative disorder in the first 20 Face Transplant recipients (10%). This rate of post-Transplant lymphoproliferative disorder is about 10 times the rate seen in solid-organ Transplant recipients. Collaborative assessment protocols are needed to determine whether the improvement in quality of life with facial Transplantation is justified in the Face of the risk of lifelong immunosuppression.
-
Face Transplantation: psychological outcomes at three-year follow-up.
Psychosomatics, 2013Co-Authors: Kathy L. Coffman, Maria SiemionowAbstract:Background The advent of Face Transplantation has raised both ethical and psychological issues. Mortality of 18 existing Face Transplant recipients is 11.1% (2/18) through 2011. Objective Psychological outcomes are as important in Face Transplantation as is restoring the Face physically. Little quantitative information has been published this area. Methods Data was systematically collected over 3 years with a Face Transplant recipient, including appearance self-rating, body image, mood changes, pain rating, perception of teasing, quality of life, self-esteem, and social reintegration. We identified a significant gap in rating instruments for use in the field, so we developed the Perception of Teasing-FaceS, Facial Anxiety Scale-State, and the Cleveland Clinic FaceS score, analogous to the model for end-stage liver disease (MELD) score for prioritizing patients for a Face Transplant registry. Results Appearance self-rating rose from 3/10 prior to Transplantation to 7/10 now. Anxiety about body image and the Facial Anxiety score were halved by the end of the third year. Beck Depression Inventory fell from 16 (prior to Transplant) to 8. Chronic daily pain was 6-7/10 prior to Transplant and 0/10 by day 50. Perception of Teasing-FaceS scores fell from 25 to 9 by the end of year 3. Quality of life improved on the Social Environment Domain of the psychological adjustment to illness scale-self-rated (PAIS-SR), where the score dropped from 15 to 1 by the end of year 3, indicating marked improvement in social reintegration. Conclusions Standardized data collection may help quantify psychological outcomes with facial Transplantation to determine whether the risks of immunosuppression over time are offset by improved quality of life for recipients.
-
Original Research Reports Face Transplantation: Psychological Outcomes at Three-Year Follow-Up
2013Co-Authors: Kathy L. Coffman, Maria Z SiemionowAbstract:Background: The advent of Face Transplantation has raised both ethical and psychological issues. Mortality of 18 existing Face Transplant recipients is 11.1% (2/18) through 2011. Objective: Psychological outcomes are as important in Face Transplantation as is restoring the Face physically. Little quantitative information has been published this area. Methods: Data was systematically collected over 3 years with a Face Transplant recipient, including appearance self-rating, body image, mood changes, pain rating, perception of teasing, quality of life, self-esteem, and social reintegration. We identified
-
Psychological outcomes with Face Transplantation: Overview and case report
Current Opinion in Organ Transplantation, 2010Co-Authors: Kathy L. Coffman, Chad R. Gordon, Maria SiemionowAbstract:PURPOSE OF REVIEW: The purpose of this review is to provide guidance in a burgeoning new field of facial composite tissue Transplantation. This review will contrast Face Transplant with solid organ Transplantation, provide information to guide selection of Face Transplant candidates, and share information on psychological outcomes. RECENT FINDINGS: Previously published Face Transplant reports have not investigated body image, mood changes, perception of teasing, quality of life, self-esteem, or social reintegration quantitatively. Face Transplantation appears to decrease depression and verbal abuse, and improve quality of life and social reintegration, though may not alter anxiety or self-esteem. The Psychosocial Adjustment for Illness Scale-Self-Report scale may have advantages over the SF-36 and World Health Organization Quality of Life (WHOQOL)-BREF rating scales for measuring psychological distress and social reintegration. SUMMARY: Face Transplantation is currently a technique of last resort after traditional reconstructive techniques have failed, not for cosmesis alone. Mortality among eight existing Face Transplant patients is 25%, two of eight. Some consider blindness as an absolute contraindication; however, those who are legally blind but retain some vision may be appropriate candidates. Physical goals of Transplantation include regaining movement of underlying structures and restoring the appearance of a normal Face. However, psychological outcomes and quality of life are also important to the success of Face Transplantation and ultimately will determine the value of the procedure.
