Posted on 01/17/2006 11:44:25 PM PST by neverdem
AP MEDICAL WRITER
TUCSON, Ariz. - French doctors treating the world's first face transplant patient say she suffered a tissue-rejection episode that threatened to cost her her new features, but she is doing well now - so well that the surgeons hope to do five more such operations soon.
"She can swallow and eat. That was impossible before the surgery. Psychologically, she's very happy," said Dr. Jean-Michel Dubernard, a surgeon from Lyon, France.
"For us, this experience is the best proof that we are right" to have done the transplant instead of trying routine reconstructive surgery, Dubernard said, referring to criticism of the operation.
However, his revelation of the rejection episode illustrates a danger the woman will live with the rest of her life, and the extraordinary risks in face transplants, which several U.S. surgeons also hope to offer soon.
The 38-year-old French woman received a new nose, chin and lips from a brain-dead donor on Nov. 27. She was severely disfigured last spring when her pet Labrador bit and scratched at her face while trying to wake her.
Dubernard spoke in an interview before the start of a transplant surgery conference in Tucson where he was to make the first scientific presentation on the operation. He brought dramatic photos, which he would not make public, showing the horrific injuries suffered by the woman, who one doctor said referred to herself as "a skeleton, a dead head."
The lower two-thirds of her nose had been ripped away. Both lips were gone, leaving her teeth bared in a grotesque grimace. The holes where nostrils once were gaped open and ghastly.
Doctors did a series of computer animations to simulate the best they thought they could do for her with routine plastic surgery, but the results appeared so dismal they decided to attempt the transplant.
About three weeks after the operation, doctors noticed the transplanted skin turning red and suspected that she had an infection. But a biopsy showed the true culprit: her immune system actually was attacking and rejecting the new face.
They tried to treat this by increasing the dose of the steroid prednisone, an immune-suppressing drug. They even gave her a face cream and mouthwash containing the medication, but they didn't help.
On Dec. 30, doctors resorted to giving her huge doses of the steroid drug, and finally succeeded in halting the rejection episode on Jan. 2.
"She was alarmed" at the prospect of losing her new face, but was relieved when it looked normal again after a few days, said Dr. Emmanuel Morelon, another of her physicians.
Since then, the woman has done so well that she can go out in a crowd without drawing lots of attention, as she did Sunday night with her psychiatrist, Dubernard said.
"They walked on the street, they went in a bar. I cannot tell you what they had to drink," Dubernard said.
Dr. Benoit Lengele, another of her physicians from Brussels, Belgium, showed recent photographs of her with just a thin, ropelike red scar around the edges of the transplanted face.
Magnetic resonance imaging, or MRI, tests show that brain areas "light up" when her new face is lightly touched, "the objective proof" that she is regaining sensation, said Dr. Bernard Devauchelle, a surgeon at University Hospital of Amiens, France, who did a large share of the transplant operation.
It is too soon to say whether a second experimental procedure the woman received - two infusions of whole bone marrow from the dead donor - will help prevent rejection, as her doctors hope, or actually aggravate it by providing more foreign tissue for her body to attack.
Dubernard has been criticized for trying that, as well as for arranging for the woman to sell the rights to photographs of herself to a longtime friend of his. Dubernard insisted that he did this to keep her from being taken advantage of.
"I want to have this thing clear on this point," Dubernard said. "We are doctors. We did it to aid the patient, not to make beaucoup," he said, rubbing his thumb and index finger together to mean money.
On Wednesday, the woman, identified only as Isabelle because of French privacy laws, plans to move back to Amiens from Lyon, where she has been receiving care. She is divorced and has two teenage girls.
Her success so far is cause for joy, but isn't likely to be repeated soon in the U.S., where surgeons consider it unethical to put a patient through the risks of a face transplant without first exhausting standard surgical remedies.
"Our approach ... is to be sure that we are not violating the borders of patients not knowing what's good or bad for them" in their desperation to look better, said Dr. Maria Siemionow, a Cleveland Clinic surgeon who is farthest along on such plans.
Since last fall, Siemionow has been screening potential candidates - burn and accident victims - and said selecting one is "a very difficult decision, more than I expected at the beginning."
Since the French operation, dozens of hopeful patients have called the clinic.
"I don't want patients worrying about who will be first," she said.
Dr. Warren Breidenbach, the University of Louisville surgeon who did the first hand transplant in the U.S., in 1999, also is working on face transplant plans, as is another group of surgeons in Louisville.
"I'm very excited about this," he said, but expanding this to more and more patients requires more study on ways to reduce the need for powerful anti-rejection drugs, which currently have to be taken lifelong and raise the risk of high blood pressure, cancer, kidney failure and other problems.
On the Net:
Transplant meeting: http://www.ctasymposium.com
I haven't heard of this before. Has anyone else and do they know if it has been successful?
I recall reading that the recipient received a transfusion from the donor. It caused controversy because it compounded interpreting the experiment. Google graft versus host disease. Rejection is host versus graft, its opposite.
This I did not know.
I will show this to the wife, as we always argue because I refuse to sleep in a room with dogs or cats.
By giving donor bone marrow, the aim is to enhance the cellular environment called mixed chimerism, defined as the coexistence of recipient and donor immune cells. It is a very delicate balance of the immune cells of both the donor and recipient. If that balance goes too far in the direction of the donor, you get GVHD (graft vs. host disease, where the host is attacked by the immune cells of the donor. Likewise, if the balance tilts to far in the direction of the recipient (host) you will see rejection of the transplanted organ and/or marrow. Achieving that balance is often done by adjusting ratios of T-cells (lymphocytes) in the donor marrow, or reducing the host's immune capability slightly by giving a one time dose of total body radiation or chemotherapy, called a conditioning regimen. The University of Pittsburg is doing studies of organ transplant patients (primarily lung and heart) using donor marrow without a conditioning regimen.
Quite intriguing that they have gotten the nerve systems to hook up, and this quickly.
The lower two-thirds of her nose had been ripped away. Both lips were gone, leaving her teeth bared in a grotesque grimace. The holes where nostrils once were gaped open and ghastly.
I have NEVER in my life heard of a dog, particularly a Labrador, waking up an owner like that. I have a 13 year old Lab we've had since she was 7 weeks old and she'd just lick you, or head-butt the bed once she got too arthritic to jump up on it.
How deeply does this woman sleep, anyway?
This is the weirdest thing I have ever read.
LQ
Ethical Concerns on Face Transplant Grow
"The psychological issues are as complex as the surgical ones. Scientists have been concerned about how thoroughly the patient was emotionally prepared for the procedure, concerns that were only heightened when The Sunday Times of London reported that she had admitted that she sustained her injuries during a suicide attempt. According to the newspaper, the woman said that she was mauled by her family's Labrador retriever after she took an overdose of sleeping pills and collapsed. She believed the dog was trying to revive her, the newspaper said. The Times also reported that the donor had committed suicide."
Ah, ok, that makes more sense then. The dog probably wasn't intentionally trying to hurt her, just frantic to wake her up and maybe tried to drag her to help by her face (bad choice on the dog's part).
LQ
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