Article
Transformation of Face Transplants: Volumetric and Morphologic Graft Changes Resemble Aging after Facial Allotransplantation
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Published: | September 28, 2015 |
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Background: Facial allotransplantation restores normal anatomy to severely disfigured faces. Although the 28 operations performed worldwide have yielded promising short-term results, long-term outcomes data remain scarce. Three full face transplant recipients were followed for 40 months. Severe changes in volume and composition of the facial allografts were noted.
Methods: All patients provided written informed consent to participate in the clinical trial for face transplantation (ClinicalTrials.gov, NCT01281267). Data from computed tomography performed 6, 18 and 36 months after transplantation were processed to separate the allograft and recipient tissues. Allograft tissues were further separated into bone, fat and non-fat soft tissues. Maximum Intensity Projection (MIP) images were used to assess soft tissue thickness. Skin and muscle biopsies obtained at protocol time points underwent diagnostic evaluation.
Results: All three facial allografts sustained significant volume loss (mean: 19.55%) between 6 and 36 months post-transplant, to an extent that depended on the tissue components. Bone and non-fat soft tissue volumes decreased significantly over time (17.22% between months 6-18 and 25.56% between months 6-36, respectively), while fat did not. MIP images revealed morphometric changes in soft tissues. Histological evaluations showed atrophy of muscle fibers, but no significant decreases in epidermal thickness.
Discussion: Volumetric and morphometric changes in facial allografts have not been previously reported. The transformation of facial allografts in this study resembles aging through volume loss, but differs substantially from regular aging. There is no epidermal thinning or atrophy of fat compartments, but rather loss of bone and non-fat soft tissue. These findings may have far reaching implications for post-transplant treatments aimed at counteracting muscle and bone atrophy.