Cugno Sabrina, Sprague Sheila, Duku Eric, Thoma Achilleas
Surgical Outcomes Research Centre (SOURCE), McMaster University, Hamilton, Ontario.
Can J Plast Surg. 2007 Fall;15(3):145-52. doi: 10.1177/229255030701500304.
Facial composite tissue allotransplantation is a potential reconstructive option for severe facial disfigurement. The purpose of the present investigation was to use decision analysis modelling to ascertain the expected quality-adjusted life years (QALYs) gained with face transplantation (versus remaining in a disfigured state) in an effort to assist surgeons with the decision of whether to adopt this procedure.
The probabilities of potential complications associated with facial allotransplantation were identified by a comprehensive review of kidney and hand transplant literature. A decision analysis tree illustrating possible health states for face allotransplantation was then constructed. Utilities were obtained from 30 participants, using the standard gamble and time trade-off measures. The utilities were then translated into QALYs, and the expected QALYs gained with transplantation were computed.
Severe facial deformity was associated with an average of 7.34 QALYs. Allotransplantation of the face imparted an expected gain in QALYs of between 16.2 and 27.3 years.
The current debate within the medical community surrounding facial composite tissue allotransplantation has centred on the issue of inducing a state of immunocompromise in a physically healthy individual for a non-life-saving procedure. However, the latter must be weighed against the potential social and psychological benefits that transplantation would confer. As demonstrated by a gain of 26.9 QALYs, participants' valuation of quality of life is notably greater for face transplantation with its side effects of immunosuppression than for a state of uncompromised physical health with severe facial disfigurement.
面部复合组织同种异体移植是严重面部毁容的一种潜在重建选择。本研究的目的是使用决策分析模型来确定面部移植（相对于保持毁容状态）所获得的预期质量调整生命年（QALY），以协助外科医生决定是否采用该手术。
通过全面回顾肾脏和手部移植文献，确定了与面部同种异体移植相关的潜在并发症的概率。然后构建了一个决策分析树，说明面部同种异体移植可能的健康状态。使用标准博弈和时间权衡方法从30名参与者那里获得效用值。然后将这些效用值转化为QALY，并计算移植所获得的预期QALY。
严重面部畸形平均与7.34个QALY相关。面部同种异体移植使QALY预期增加16.2至27.3年。
医学界目前围绕面部复合组织同种异体移植的争论集中在为非挽救生命的手术而使身体健康的个体进入免疫妥协状态这一问题上。然而，必须将后者与移植可能带来的潜在社会和心理益处进行权衡。正如26.9个QALY的增加所表明的，参与者对生活质量的评估是，免疫抑制有副作用的面部移植比身体健康但严重面部毁容的状态要高得多。
