title: First human face transplantation:  5 years outcomes.
abstract: BACKGROUND
  The first human facial allotransplantation, a 38-year-old woman, was performed on November 27, 2005. The aesthetic aspect and functional recovery and the risk-to-benefit ratio are evaluated 5 years later.
  
  
  METHODS
  The facial transplantation included nose, chin, part of cheeks, and lips. The immunosuppressive protocol included tacrolimus, mycophenolate mofetil, prednisone, and antithymocyte globulins. In addition, donor bone marrow cells were infused on days 4 and 11 after transplantation.
  
  
  RESULTS
  The aesthetic aspect is satisfying. The patient has normal protective and discriminative sensibility. She showed a rapid motion recovery, which has remained stable for 3 years posttransplantation. She can smile, chew, swallow, and blow normally whereas pouting and kissing is still difficult. Phonation recovery was impressive therefore the patient can talk normally. Two episodes of acute rejection developed during the first year. Donor-specific anti-human leukocyte antigen antibodies were never detected. Five-year mucosal biopsy showed a slight perivascular inflammatory infiltrate while skin biopsy was normal. The main side effect of the immunosuppressive treatment was a progressive decrease in renal function, which improved after switching from tacrolimus to sirolimus. Moreover, she developed arterial hypertension, an increase in lipid levels, and in situ cervix carcinoma treated by conization. Since 2008, she showed mild cholangitis possibly caused by sirolimus. In September 2010, bilateral pneumopathy occurred and was successfully treated with antibiotics.
  
  
  CONCLUSIONS
  Despite some long-term complications, which are similar to those reported after solid organ transplantation, the patient is satisfied of her new face and has normal social interaction.
authors.affiliation: Department of Transplantation, Hôpital Edouard Herriot, HCL, Lyon, France. petruzzo@medicina.unica.it
authors.forename: Palmina
authors.initials: P
authors.lastname: Petruzzo
authors.forename: Sylvie
authors.initials: S
authors.lastname: Testelin
authors.forename: Jean
authors.initials: J
authors.lastname: Kanitakis
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.forename: Benoit
authors.initials: B
authors.lastname: Lengelé
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Girbon
authors.forename: Hélène
authors.initials: H
authors.lastname: Parmentier
authors.forename: Christophe
authors.initials: C
authors.lastname: Malcus
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Bernard
authors.initials: B
authors.lastname: Devauchelle
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Dubernard
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D054445:Facial Transplantation / Q000009:adverse effects / Q000379:methods* / Q000473:pathology / Q000502:physiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D016131:Lymphocyte Subsets / Q000276:immunology; D008279:Magnetic Resonance Imaging; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine