Risk assessment of immunosuppressive therapy in facial transplantation.
BACKGROUND
Immunosuppression-related risks are foremost among ethical concerns regarding facial transplantation. However, previous risk estimates are inaccurate and misleading, because they are based on data from studies using different immunosuppression regimens, health status of the transplant recipients, tissue composition, and antigenicity. This review provides a comprehensive risk assessment for facial transplantation based on comparable data of immunosuppression, recipient health status, and composition and antigenicity of the transplanted tissue.


METHODS
The risk estimates for face transplantation presented here are based on data reported in clinical kidney (10-year experience) and hand transplantation (5-year experience) studies using tacrolimus/mycophenolate mofetil/corticosteroid therapy. Mitigating factors including ease of rejection diagnosis, rejection reversibility, infection prophylaxis, patient selection, and viral serologic status are taken into account.


RESULTS
Estimated risks include acute rejection (10 to 70 percent incidence), acute rejection reversibility (approximating 100 percent with corticosteroid therapy alone), chronic rejection (<10 percent over 5 years), cytomegalovirus disease (1 to 15 percent), diabetes (5 to 15 percent), hypertension (5 to 10 percent), and renal failure (<5 percent).


CONCLUSIONS
A review of these data indicates that previously reported estimates of immunosuppression-related risks are outdated and therefore should no longer be used. These updated risk estimates should be used by facial transplant teams, institutional review boards, and potential recipients when considering the immunologic risks associated with facial transplantation.
Vasilic
Dalibor
D
Louisville, Ky.; Cincinnati, Ohio; and Utrecht, The Netherlands From the Departments of Surgery and Sociology, University of Louisville; Division of Nephrology, Department of Internal Medicine, and Division of Transplantation, Department of Surgery, University of Cincinnati; and Department of Plastic, Reconstructive, and Hand Surgery, University of Utrecht.
Alloway
Rita R
RR
Barker
John H
JH
Furr
Allen
A
Ashcroft
Rachael
R
Banis
Joseph C
JC
Kon
Moshe
M
Woodle
E Steve
ES
D005145:Face / Q000601:surgery*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016377:Organ Transplantation; D018570:Risk Assessment
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