title: Face Transplantation: Partial Graft Loss of the First Case 10 Years Later.
abstract: Ten years after the first face transplantation, we report the partial loss of this graft. After two episodes of acute rejection (AR) occurred and completely reversed in the first posttransplantation year, at 90 months posttransplantation the patient developed de novo class II donor-specific antibodies, without clinical signs of AR. Some months later, she developed several skin rejection episodes treated with steroid pulses. Despite rapid clinical improvement, some months later the sentinel skin graft underwent necrosis. Microscopic examination showed intimal thickening, thrombosis of the pedicle vessel, and C4d deposits on the endothelium of some dermal vessels of the facial graft. Flow magnetic resonance imaging of the facial graft showed a decrease of the distal right facial artery flow. Three steroid pulses of 500 mg each, followed by intravenous immunoglobulins (2 g/kg), five sessions of plasmapheresis, and three cycles of bortezomib 1.3 mg/m2, were administered. Despite rescue therapy with eculizumab, necrosis of the lips and the perioral area occurred, which led to surgical removal of the lower lip, labial commissures, and part of the right cheek in May 2015. In January 2016, the patient underwent conventional facial reconstruction because during the retransplantation evaluation a small-cell lung carcinoma was discovered, causing the patient's death in April 2016.
authors.affiliation: Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.|INSERM U 1111, Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Morelon
authors.affiliation: Department of Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.|Department of Surgery, University of Cagliari, Cagliari, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Petruzzo
authors.affiliation: Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Kanitakis
authors.affiliation: Department of Maxillofacial Surgery, CHU Amiens-Picardie, Facing Faces Institute, Amiens, France.
authors.forename: S
authors.initials: S
authors.lastname: Dakpé
authors.affiliation: Department of Transplantation, Nephrology and Clinical Immunology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.|INSERM U 1111, Lyon, France.
authors.forename: O
authors.initials: O
authors.lastname: Thaunat
authors.affiliation: Laboratoire HLA, Etablissement Français du Sang Rhône Alpes, Lyon, France.
authors.forename: V
authors.initials: V
authors.lastname: Dubois
authors.affiliation: Nephrology, Dialysis and Transplantation Department, CHU Amiens Picardie, Amiens, France.
authors.forename: G
authors.initials: G
authors.lastname: Choukroun
authors.affiliation: Department of Maxillofacial Surgery, CHU Amiens-Picardie, Facing Faces Institute, Amiens, France.
authors.forename: S
authors.initials: S
authors.lastname: Testelin
authors.affiliation: Department of Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Dubernard
authors.affiliation: Department of Transplantation, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: L
authors.initials: L
authors.lastname: Badet
authors.affiliation: Department of Maxillofacial Surgery, CHU Amiens-Picardie, Facing Faces Institute, Amiens, France.
authors.forename: B
authors.initials: B
authors.lastname: Devauchelle
mesh_terms: D000328:Adult; D054445:Facial Transplantation / Q000009:adverse effects*; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007518:Isoantibodies / Q000097:blood; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D012086:Reoperation; D013997:Time Factors
chemical_list: D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies
keywords: clinical research/practice; rejection: antibody-mediated (ABMR); rejection: chronic; vascularized composite and reconstructive transplantation