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FACE ALLOGRAFT

Nowadays it is questioned whether is possible to perform a “face transplant”.

A face transplant would be indicated for patients who “do not have a face”. These borderline cases are possible as results of severe traumas and burns.

A missing face has an obvious psicologycal impact on the person: the face is the individual’s social identity, and its visiting card. Whithout a face, the individual cannot socialize in a reasonable way. As a result, the social and psychological impact is absolutely huge. At most, these people wear a mask that covers their faces.

The face transplant does not try to satisfy a people who is not happy with some physical defect. It would be set out in extreme cases. In this way, ethical and moral either considerations hypothetic psychological impact of the transplant have no relavance against the magnitude of the deformity. There’s no ethical and moral peculiarity in getting a vital organ for social life as face is to be surgically transferred from a donor corpse to a patient who does not have a face.

     Is the face transplant surgically possible?

     Yes, it’s possible. We have the necessary technical resources to transplant a face. In fact there are many research teams around the world in this field. It would be a microsurgical transplant consisting of fixing all the face face nerves, arteries and veins, salivary ducts, and the reconstruction of all the commisures of the face.

REQUIREMENTS FOR A FACE TRANSPLANT:

     In the Pedro Cavadas Fundation, aware of the magnificiency of the impairment a missing face results, have started a program to offer a face transplant to selected patients.

WE ARE NOT TAKING INTO CONSIDERATION PATIENTS WHO DO NOT LIVE IN SPAIN. E-MAIL QUESTIONS ABOUT PATIENTS WHO DO NOT FULFILL THIS REQUIREMENT WILL NOT BE ANSWERED.

CANDIDATES REQUIREMENTS:

  1. Hard traumatic or burn face damage.
  2. Age: Between 18 and 50 year old.
  3. Live in Spain and be covered my the national health system.
  4. Not to be a smoker. No overweight. No diabetes. No ischemic cardiomyopathy.
  5. Must be prepared to start a surgical and rehabilitatory process that will last almost two years.
  6. It’s mandatory to live in the city of Valencia (Spain), for almost 8 months after the transplantation, and later in Spain while the patient keeps the transplanted face.
  7. Lack of significant illnesses, and specially tumors, in the last 10 years.
  8. Must be ready to take drugs that prevent rejection while the patient keeps the transplanted face, and until the doctors think it’s necessary.
BASIC TESTS THAT MUST PROVIDE ALL CANDIDATES THAT MEET ALL REQUIREMENTS ABOVE:
  1. Bool group.
  2. Viral serology: HBV, HCV, HIV.
  3. Viral serology: CMV, EBV.
  4. Biochemistry: Grucose, urea, creatinine.
  5. Psychiatric report, where must be specified that the candidate does not present any process that contraindicates the transplant.
  6. lymphocytotoxic antibodies(anti-HLA)
BASIC INFORMATION ABOUT THE ANTI-REJECTION DRUGS (IMMUNOSUPPRESSANT TREATMENT):

     The candidate will be informed about aboout the anti-rejection drugs required during the years will last the transplant. This medication MUST NOT be supressed, and is taken into strict medical control.

  1. TACROLIMUS: Calcineurin inhibitor that inhibits the IL-2. Its main side effects are::
    • Hypertension: maybe its appearance, requiring antihypertensive treatment until the voltages are well controlled. Sometimes you need to keep their maintenance while the transplant.
    • Hyperglycemia: its toxic effect at pancreatic, causes increased blood glucose. Often be corrected with medication, which is necessary for several weeks.
    • Chronic renal failure occurs gradually and cumulatively over the months and years. When removing the medication only partially restored. To avoid the need to avoid NSAIDs, and maintain adequate hydration, drinking at least three liters of water a day.
    • Neurotoxicity: manifested by tremors and headaches. Are rare and reversible.
    • This drug interacts with many drugs. The introduction of new drugs should be reviewed by our medical team.
    • Measurements are needed drug blood levels weekly to achieve the desired levels, intermediate between avoiding rejection and minimize the risk of side effects.
  2. MYCOPHENOLATE MOFETIL: Acts by inhibiting the metabolism of inosine. Its main side effects are:
    • Gastrointestinal complaints, which are controlled by dietary measures and medication occasionally.
    • Risk of blood proliferative disorders: 1% of leukemia in patients with transplanted kidney. Has not been observed in patients with transplanted hands.
    • Severe esophagitis, observed in 5% of transplanted kidneys, and associated with CMV infection (CMV).
  3. CORTICOSTEROIDS: inhibit dendritic cells, which are the most potent antigen-presenting. Its main side effects are:
    • Weight gain fluid retention.
    • Hypertension.
    • Hyperglycemia.
    • Osteoporosis and hip fracture. Observed in one time after a hand transplant. Requiring surgical intervention.
  4. ALEMTUZUMAB: A genetically modified antibody that depletes lymphocytes, and prevents the rejection between 3 and 9 months. Its main side effects are the reactivation of CMV, thyroiditis and serum sickness.

     These drugs were designed to prevent rejection in solid organ transplant (kidney, heart, liver, etc.).. The use of these drugs for the transplantation of hands on a large scale has not been authorized by the Ministry of Health. Its use is possible only with the written consent of the patient, the so-called “compassionate use.” The signing of the compassionate use of this medication the patient is known that these drugs were designed for other purposes, which at the moment is to rely on them as there are no other ways to prevent rejection, and assuming the risks arising from the use of these drugs.

    The use of this medication has kept in good condition 100% of the hand transplants performed in Europe and the U.S.. The risk of rejection episodes is 1.5 episodes per year during the first 2 years. Subsequently, the risk decreases, and there has been no rejection episodes within 4 years. During the post-transplant period, both short and long term, we try to reduce the medication to avoid side effects while maintaining the patient free of rejection.

    After discharge, the transplant recipient must reside in the city of Valencia, for intensive rehabilitation treatment and stay close to medical equipment. CMV controls were carried out for several weeks and tacrolimus.

     The emergence of a suspected rejection episode required immediately move to the Hospital Universitario “La Fe” to proceed to the entry and biopsy under local anesthesia, and increased medication. After inspecting the rejection, the patient will be discharged, requiring new weekly checks of drug levels in blood.

     Reactivation of cytomegalovirus (CMV) has been observed in patients with anti-rejection treatment. It is important to know whether the infection was before the transplant. CMV infection requiring hospitalization and treatment since the onset of CMV is highly associated with the onset of rejection.

Once known and assumed the risks of medication, a study was carried out preoperatively in the Hospital Universitario “La Fe” of Valencia. After checking that there are no medical contraindications, the patient will be included on the waiting list for transplantation.

FOR MORE INFORMATION PLEASE CONTACT US. RECEIVER WILL BE EVALUATED AND WILL BE GIVEN MORE INFORMACION IN FURTHER INTERVIEWS.