Do Face Transplants Work and what are the survival rates? Review of First 50 patients (males dominated), Globally since 2005 by fewer than 20 surgeons worldwide

What a medical specialty! If you need one, you can only choose among 20 or so experts in this field around the world.

Note each patient received only one face transplant, but there were transplant losses and retransplants.

10 patients died!

"Since 2005, only 50 face transplants have been performed worldwide—10 of them by Bohdan Pomahac, MD, Frank F. Kanthak Professor of Surgery (Plastics) and chief of plastic and reconstructive surgery at Yale School of Medicine. With very few procedures being done every year and fewer than 20 surgeons around the world with the expertise to perform these transplants, the field to date has been somewhat fragmented, Pomahac said.

That’s now starting to change—for the first time, Pomahac and his counterparts have come together to share data and compare notes. In a recently published article in the journal JAMA Surgery, they describe how the world’s first 50 face transplants (performed on 48 patients) have fared. These 50 transplants occurred in 11 countries in North America, Europe, and Asia. ..."

From the key points and abstract:

"Key Points

Question  What is the overall survival of the first 50 face transplants in the world?

Findings
This cohort study on the first 50 face transplants, performed in 18 centers across 11 countries between 2005 and 2021 demonstrated 5- and 10-year survival of the transplants at 85% and 74%, respectively.

Meaning  These results demonstrate that with the encouraging overall survival rate of the face transplants, the procedure can be seen as an effective reconstructive option for patients with severe facial defects.

Abstract

Importance  Since 2005, a total of 50 face transplants have been reported from 18 centers in 11 countries. The overall survival of the grafts has not yet been established.

Objective

To assess the survival of the face transplant grafts and evaluate factors potentially influencing it.

Design, Setting, and Participants
Data on all the transplants included in this multicenter cohort study were collected at participating transplant centers for updated nonpublished data, supplemented with literature review for nonparticipating centers. Data from 2005 until September 2023, were included. Data were analyzed from November 11, 2005, through September 18, 2023. Patients included the first 50 patients in the world to have received a face transplant.

Exposure  Face transplant graft.

Main Outcomes and Measures
The primary outcome was the overall survival of the face transplant graft, defined as either transplant loss or patient death. The secondary outcome was the number of acute rejection episodes per year.

Results

The 50 transplants were performed on 39 men (81%) and 9 women (19%) with a median age of 35 (range, 19-68) years at the time of the transplant. The median follow-up time was 8.9 (range, 0.2-16.7) years. During the follow-up, 6 transplants were lost with 2 patients retransplanted. There were 10 patients who died, 2 of whom had lost a transplant. The 5- and 10-year survival of the transplants was 85% (SD, 5%) and 74% (SD, 7%), respectively. The sequential number of the transplant in the world was a significant predictor of survival (hazard ratio, 95; 95% CI, 90-100; P < 05). The median number of acute rejection episodes per year was 1.2 (range, 0-5.3) for the transplants that were lost and 0.7 (range, 0-4.6) for the transplants that survived. No correlation with patient and transplant variables was detected for either the transplant survival or the number of rejection episodes.

Conclusions and Relevance
In this study, the overall survival of the face transplants is encouraging. These data suggest that the acceptable long-term survival of face transplants makes them a reconstructive option for extensive facial defects."

Do Face Transplants Work? Review of First 50, Globally, Says Yes < Yale School of Medicine

An Update on the Survival of the First 50 Face Transplants Worldwide (no public access)

Bohdan Pomahac, MD