French face transplant stirs controversy

Lyon, France - A partial face transplant recently performed in France raises both technical and ethical concerns, doctors and ethicists tell Dermatology Times.

In late November, a team of surgeons led by Dr. Bernard Devauchelle, M.D., Ph.D., F.R.C.S., head of maxillofacial surgery, CHU Amiens, transplanted the lips, chin and nose of a cadaver donor to a female patient. The woman had been mauled by her dog in May, according to Benoit Lengele, M.D., Ph.D., a member of the surgical team and professor of anatomy and reconstructive microsurgery at the Catholic University of Louvain in Brussels, Belgium.

Dr. Lengele says work began a little over six months ago when the severely disfigured patient was admitted to CHU Amiens. In his anatomy lab, doctors studied each step of the transplant procedure in detail and simultaneously requested ethical agreements from the French Biomedical Agency to obtain all permissions necessary to perform the operation. Their planning completed, the doctors eventually received notification that a potential donor was available in Lille.

No complications

At press time, the doctors had transferred the patient to Lyon for late postoperative follow-up, including immunotherapy overseen by Jean-Michel Dubernard, M.D., of Hopital Edouard Herriot de Lyon, the leading French expert in composite tissue allotransplantation, according to Dr. Lengele. Dr. Dubernard also helped plan the operation.

Two weeks after the procedure, Dr. Lengele told Dermatology Times the patient suffered "absolutely no surgical or other complications.

"For the moment," he adds, "the prognosis of the graft is excellent because there's been no rejection and the integration into the face is perfect."

Along with giving the patient standard antirejection drugs, Dr. Lengele reports, "We made an infusion of stem cells (from the donor's bone marrow) because it was observed in hand transplantation that the donor marrow that had been transplanted in the bones of the forearm gave rise to lymphocytes in the circulation of the recipient, inducing a microchimerism believed to favor the immune tolerance of the graft."

According to Laurent Lantieri, M.D., combining the facial transplant with stem cell infusion amounts to performing two experimental procedures simultaneously, an approach that would make it difficult to determine which contributed more to success or failure. He is professor and head of plastic surgery, CHU Henri Mondor Hospital, APHP, Creteil, France, and head of the hospital's face transplant project, which he says has won ethical approval and has begun screening patients.

Regarding the combination of procedures, Dr. Lengele says that had the surgery itself failed, a problem would already have surfaced. The immunology, he says, is "another question. There's no interference between the two procedures. The aesthetic benefit is obvious. We now need a one-year follow-up to be able to (document) the exact functional benefit of the operation."