title: Face transplantation:  outcomes, concerns, controversies, and future directions.
abstract: BACKGROUND
  Since 2005, 17 facial allotransplantations have been performed worldwide. The brief summary of current cases with ongoing concerns is presented in this article.
  
  
  METHODS
  Fifteen publications were reported for 10 facial allotransplantations. For the remaining 7 transplantations, information was gathered from scientific meeting presentations and media releases. The summary of current cases in terms of etiology, indications, results, complications, and outcomes are based on these data. The discussion of ongoing concerns, controversies, and overview of future implications is accomplished by reviewing the literature of ethical debates, experimental studies, clinical studies, and personal opinion.
  
  
  RESULTS
  Two of the 17 face transplant recipients died. Overall survival rate was 88%. No early graft loss due to technical failure was reported. All reported cases that have more than 1-year follow-up had at least 1 acute rejection episode, which was reversible with treatment. Opportunistic infections and metabolic complications were observed as adverse effects. Motor recoveries were slower than the sensorial recoveries, as expected. Functional and aesthetic outcomes were satisfactory. Concerns and controversies about concomitant face and hand transplantation, recipient blindness, recipient age, primary reconstruction option in facial trauma cases, funding, graft failure risks, and future treatment options are discussed.
  
  
  CONCLUSIONS
  Because of uncertainty about long-term outcomes, immunosuppression-related concerns and ethical debates limit worldwide application of facial allotransplantation. However, in selected group of patients, it is a unique reconstruction method with promising outcomes. Further research and investigation in transplant immunology and treatment hold the key to advance this treatment option.
authors.affiliation: Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. siemiom@ccf.org
authors.forename: Maria
authors.initials: M
authors.lastname: Siemionow
authors.forename: Can
authors.initials: C
authors.lastname: Ozturk
mesh_terms: D004954:Esthetics; D054445:Facial Transplantation / Q000941:ethics / Q000379:methods* / Q000502:physiology / Q000639:trends; D005544:Forecasting; D006084:Graft Rejection / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D015996:Survival Rate; D016896:Treatment Outcome