French face transplant patient in fight to stop tissue rejection

Jan 19 2006

At a medical conference in Tucson Arizona, the French surgeons responsible for carrying out the world's first face transplant have admitted they had to fight for several days against the first signs of rejection.

Dr. Jean-Michel Dubernard, who led the team that performed the pioneering transplant in France last November, said they finally overcame the threat to her new face after the woman was given huge doses of steroids.

Her French doctors admit the patient has resumed smoking which is a concern to them as they fear it could interfere with the healing process and raise the risk of tissue rejection.

The French surgeons made their first scientific presentation on the partial face transplant at the medical conference and said that despite the scare, which arose over Christmas and continued until early January, they viewed the operation as a success.

They say they hope to offer such transplants to more patients.

The patient, a divorced mother of two teenage girls from Valenciennes, northern France, was given a new nose, chin and lips in late November, five months after she was disfigured when her dog tore at her face in an attempt to wake her.

She received a new nose, chin and lips from a brain-dead donor.

Apparently three weeks after the surgery, the woman's transplanted skin began to turn red, and tests showed the new tissue was being attacked by the patient's own immune system.

When efforts using increased doses of the steroid prednisone, along with a facial cream and mouthwash containing the same drug failed, the steroid dosage was significantly increased, finally halting the process of rejection and restoring the original appearance of the transplanted face.

According to Dubernard, since then the woman has made excellent progress and is now able socialise without attracting excessive attention.

She is reportedly very happy.

Professor Bernard Devauchelle, who jointly led the team conducting the operation at an Amiens hospital, said MRI tests showed the patient's brain areas "lit up" in response to light physical contact with her new face, offering "objective proof" that sensation was returning.

Professor Dubernard defended his role in arranging photographs of the woman to be sold to the media, saying this was done to prevent others taking advantage of her.

Many doctors at the conference believe the debate over ethics is over and the focus should now be on making such transplants as safe and as widely available as possible.

Problems with other novel types of transplants were also revealed at the medical conference, with an almost 90 percent success rate recorded among the 24 hand transplants performed to date.

A Chinese surgeon shocked the conference by reporting that up to half of the nine or so patients in his country have since rejected the new organs because they could not afford the immune-suppressing drugs.

According to Dr. Frederic Schuind, a surgeon at Hospital Erasme - Université Libre de Bruxelles, a hand transplant recipient in his country had made "a mild suicide attempt."

The patient had been deemed psychologically stable enough to undergo the operation even though he had attempted suicide as a teenager.

These incidents prompted several surgeons to say that such transplants should not be done unless surgeons first ensure patients are psychologically healthy and are prepared to take anti-rejection drugs for the rest of their lives.