Kauke Martin, Panayi Adriana C, Safi Ali-Farid, Haug Valentin, Perry Bridget, Kollar Branislav, Nizzi Marie-Christine, Broyles Justin, Annino Donald J, Marty Francisco M, Sinha Indranil, Lian Christine G, Murphy George F, Chandraker Anil, Pomahac Bohdan
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, Massachusetts, USA.
Am J Transplant. 2021 Oct;21(10):3472-3480. doi: 10.1111/ajt.16696. Epub 2021 Jul 22.
There is limited experience with facial retransplantation (fRT). We report on the management of facial retransplantation in a facial vascularized composite allotransplant recipient following irreversible allograft loss 88 months after the first transplant. Chronic antibody-mediated rejection and recurrent cellular rejection resulted in a deteriorated first allograft and the patient underwent retransplantation. We summarize the events between the two transplantations, focusing on the final rejection episode. We describe the surgical technique of facial retransplantation, the immunological and psychosocial management, and the 6-month postoperative outcomes. Removal of the old allograft and inset of the new transplant were done in one operation. The donor and recipient were a good immunological match. The procedure was technically complex, requiring more proximal arterial anastomoses and an interposition vein graft. During the first and second transplantation, the facial nerve was coapted at the level of the branches. There was no hyperacute rejection in the immediate postoperative phase. Outcomes 6 months postoperatively are promising. We provide proof-of-concept that facial retransplantation is a viable option for patients who suffer irreversible facial vascularized composite allograft loss.
面部再次移植（fRT）的经验有限。我们报告了一名面部血管化复合异体移植受者在首次移植88个月后出现不可逆的移植物丢失后进行面部再次移植的管理情况。慢性抗体介导的排斥反应和复发性细胞排斥反应导致首次移植的移植物恶化，患者接受了再次移植。我们总结了两次移植之间的事件，重点关注最终的排斥反应。我们描述了面部再次移植的手术技术、免疫和心理社会管理以及术后6个月的结果。在一次手术中完成了旧移植物的切除和新移植物的植入。供体和受体在免疫学上匹配良好。该手术技术复杂，需要更多近端动脉吻合和一段静脉移植。在第一次和第二次移植过程中，面神经在分支水平进行了吻合。术后即刻没有发生超急性排斥反应。术后6个月的结果很有希望。我们提供了概念验证，即面部再次移植对于遭受不可逆面部血管化复合异体移植物丢失的患者是一种可行的选择。
