Homsy Pauliina, Huelsboemer Lioba, Barret Juan P, Blondeel Phillip, Borsuk Daniel E, Bula Daniel, Gelb Bruce, Infante-Cossio Pedro, Lantieri Laurent, Mardini Samir, Morelon Emmanuel, Nasir Serdar, Papay Francis, Petruzzo Palmina, Rodriguez Eduardo, Özkan Özlenen, Özmen Selahattin, Pomahac Bohdan, Lassus Patrik
Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki. Puistosairaala, HUS, Finland.
Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, Connecticut.
JAMA Surg. 2024 Dec 1;159(12):1339-1345. doi: 10.1001/jamasurg.2024.3748.
Since 2005, a total of 50 face transplants have been reported from 18 centers in 11 countries. The overall survival of the grafts has not yet been established.
To assess the survival of the face transplant grafts and evaluate factors potentially influencing it.
DESIGN, SETTING, AND PARTICIPANTS: Data on all the transplants included in this multicenter cohort study were collected at participating transplant centers for updated nonpublished data, supplemented with literature review for nonparticipating centers. Data from 2005 until September 2023, were included. Data were analyzed from November 11, 2005, through September 18, 2023. Patients included the first 50 patients in the world to have received a face transplant.
Face transplant graft.
The primary outcome was the overall survival of the face transplant graft, defined as either transplant loss or patient death. The secondary outcome was the number of acute rejection episodes per year.
The 50 transplants were performed on 39 men (81%) and 9 women (19%) with a median age of 35 (range, 19-68) years at the time of the transplant. The median follow-up time was 8.9 (range, 0.2-16.7) years. During the follow-up, 6 transplants were lost with 2 patients retransplanted. There were 10 patients who died, 2 of whom had lost a transplant. The 5- and 10-year survival of the transplants was 85% (SD, 5%) and 74% (SD, 7%), respectively. The sequential number of the transplant in the world was a significant predictor of survival (hazard ratio, 95; 95% CI, 90-100; P < 05). The median number of acute rejection episodes per year was 1.2 (range, 0-5.3) for the transplants that were lost and 0.7 (range, 0-4.6) for the transplants that survived. No correlation with patient and transplant variables was detected for either the transplant survival or the number of rejection episodes.
In this study, the overall survival of the face transplants is encouraging. These data suggest that the acceptable long-term survival of face transplants makes them a reconstructive option for extensive facial defects.
自2005年以来，11个国家的18个中心共报告了50例面部移植手术。移植物的总体存活率尚未确定。
评估面部移植移植物的存活率，并评估可能影响其存活率的因素。
设计、地点和参与者：本多中心队列研究纳入的所有移植手术的数据在参与的移植中心收集，以获取最新的未发表数据，并对未参与的中心进行文献综述补充。纳入了2005年至2023年9月的数据。数据分析时间为2005年11月11日至2023年9月18日。患者包括世界上首批接受面部移植的50名患者。
面部移植移植物。
主要结局是面部移植移植物的总体存活率，定义为移植失败或患者死亡。次要结局是每年急性排斥反应发作的次数。
50例移植手术的对象为39名男性（81%）和9名女性（19%），移植时的中位年龄为35岁（范围19 - 68岁）。中位随访时间为8.9年（范围0.2 - 16.7年）。随访期间，6例移植失败，2例患者再次移植。有10例患者死亡，其中2例移植失败。移植的5年和10年存活率分别为85%（标准差5%）和74%（标准差7%）。世界上移植手术的顺序号是存活率的显著预测因素（风险比，95；95%可信区间，90 - 100；P < 0.05）。移植失败的患者每年急性排斥反应发作的中位次数为1.2次（范围0 - 5.3次），存活患者为0.7次（范围0 - 4.6次）。未检测到移植存活率或排斥反应发作次数与患者及移植变量之间的相关性。
在本研究中，面部移植的总体存活率令人鼓舞。这些数据表明，面部移植可接受的长期存活率使其成为广泛面部缺损的一种重建选择。
