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French Face Transplant Patient 'Perfect,' Doctors Report
Thursday, December 13, 2007
ATLANTA - Two years after French doctors stunned the world with the first
partial face transplant, other doctors remain cautious about pursuing the
surgery.
The French patient, Isabelle Dinoire, has a new face that resembles and
moves like the one she was born with. Her doctors celebrate how far she has
come in an article this week in the New England Journal of Medicine.
"She's perfect," said Dr. Jean-Michel Dubernard, the lead surgeon on the
operation, in an interview.
Her recovery has been remarkable but difficult. Dinoire's post-transplant
life has been full of complications, including kidney failure and two
episodes in which her body's immune system tried to reject the new skin.
At the two U.S. hospitals planning face transplants, doctors say it is hard
to judge how well some treatments used by the French would work on other
patients. They also questioned whether Dinoire can be depended upon to keep
taking immune-suppressing drugs the rest of her life.
Failure to do so could lead to the face sloughing away. "It could lead to a
disaster," said Dr. Bohdan Pomahac, a plastic surgeon at Brigham and Women's
Hospital in Boston.
Dinoire had the transplant in November 2005 in France. She was horribly
disfigured six months earlier, when her pet Labrador chewed her face while
she was passed out from an overdose of sleeping pills.
She lost the end of her nose, lips, chin and parts of her cheeks. "She was
unable to speak, unable to eat. She was fed by a gastric tube," Dubernard
said.
The donor was a brain-dead, 46-year-old woman. Doctors took not only her
face but also bone marrow cells, which they injected into Dinoire shortly
after the operation.
Skin transplants are highly susceptible to rejection, and it was clear
Dinoire would need powerful doses of anti-rejection drugs. But the
physicians hoped the donor bone marrow cells would help Dinoire's immune
system accept the transplant.
Dinoire still suffered rejection symptoms, twice - once a month after her
surgery and again in June 2006. After the second episode, doctors started a
treatment that exposed her white blood cells to ultraviolet radiation to
weaken the immune response.
Meanwhile, her kidney function deteriorated, until one of the
immune-suppressing drugs was replaced in the fall of 2006 and she improved.
She has also had a couple of small infections, including a cold sore on her
new lip and tiny white pox across her cheeks.
Since Dinoire, two other partial face transplants have been reported.
Last year, a Chinese farmer received one after he was disfigured in a bear
attack. In January, French doctors performed one on a man disfigured by a
genetic condition. Dubernard said he was not involved in those operations.
Brigham and Women's Hospital is one of the U.S. hospitals preparing to do
face transplants. In May, doctors there won approval from the institutional
review board, the hospital's gatekeeper for research projects. The program
is working with an organ bank and expects to enroll patients next year, said
Pomahac, who runs the Brigham program.
The Cleveland Clinic won approval from its in-house review board in 2004 and
has been developing donor consent procedures and identifying patients who
are most physically in need and most mentally capable of dealing with a
transplant.
Alluding to reports that Dinoire's overdose was a suicide attempt, Siemionow
called her "psychologically questionable as a candidate" for a face
transplant.
Siemionow declined to predict when the first transplant at her own hospital
might occur.
Still, U.S. doctors marvel at the reported improvements in Dinoire's ability
to eat and drink, feel sensations on her face, and talk and smile.
"This has been a very successful surgical exercise," said Dr. W.P. Andrew
Lee, chief of plastic surgery at the University of Pittsburgh School of
Medicine.
French Face Transplant Patient 'Perfect,' Doctors Report
Thursday, December 13, 2007
ATLANTA - Two years after French doctors stunned the world with the first
partial face transplant, other doctors remain cautious about pursuing the
surgery.
The French patient, Isabelle Dinoire, has a new face that resembles and
moves like the one she was born with. Her doctors celebrate how far she has
come in an article this week in the New England Journal of Medicine.
"She's perfect," said Dr. Jean-Michel Dubernard, the lead surgeon on the
operation, in an interview.
Her recovery has been remarkable but difficult. Dinoire's post-transplant
life has been full of complications, including kidney failure and two
episodes in which her body's immune system tried to reject the new skin.
At the two U.S. hospitals planning face transplants, doctors say it is hard
to judge how well some treatments used by the French would work on other
patients. They also questioned whether Dinoire can be depended upon to keep
taking immune-suppressing drugs the rest of her life.
Failure to do so could lead to the face sloughing away. "It could lead to a
disaster," said Dr. Bohdan Pomahac, a plastic surgeon at Brigham and Women's
Hospital in Boston.
Dinoire had the transplant in November 2005 in France. She was horribly
disfigured six months earlier, when her pet Labrador chewed her face while
she was passed out from an overdose of sleeping pills.
She lost the end of her nose, lips, chin and parts of her cheeks. "She was
unable to speak, unable to eat. She was fed by a gastric tube," Dubernard
said.
The donor was a brain-dead, 46-year-old woman. Doctors took not only her
face but also bone marrow cells, which they injected into Dinoire shortly
after the operation.
Skin transplants are highly susceptible to rejection, and it was clear
Dinoire would need powerful doses of anti-rejection drugs. But the
physicians hoped the donor bone marrow cells would help Dinoire's immune
system accept the transplant.
Dinoire still suffered rejection symptoms, twice - once a month after her
surgery and again in June 2006. After the second episode, doctors started a
treatment that exposed her white blood cells to ultraviolet radiation to
weaken the immune response.
Meanwhile, her kidney function deteriorated, until one of the
immune-suppressing drugs was replaced in the fall of 2006 and she improved.
She has also had a couple of small infections, including a cold sore on her
new lip and tiny white pox across her cheeks.
Since Dinoire, two other partial face transplants have been reported.
Last year, a Chinese farmer received one after he was disfigured in a bear
attack. In January, French doctors performed one on a man disfigured by a
genetic condition. Dubernard said he was not involved in those operations.
Brigham and Women's Hospital is one of the U.S. hospitals preparing to do
face transplants. In May, doctors there won approval from the institutional
review board, the hospital's gatekeeper for research projects. The program
is working with an organ bank and expects to enroll patients next year, said
Pomahac, who runs the Brigham program.
The Cleveland Clinic won approval from its in-house review board in 2004 and
has been developing donor consent procedures and identifying patients who
are most physically in need and most mentally capable of dealing with a
transplant.
Alluding to reports that Dinoire's overdose was a suicide attempt, Siemionow
called her "psychologically questionable as a candidate" for a face
transplant.
Siemionow declined to predict when the first transplant at her own hospital
might occur.
Still, U.S. doctors marvel at the reported improvements in Dinoire's ability
to eat and drink, feel sensations on her face, and talk and smile.
"This has been a very successful surgical exercise," said Dr. W.P. Andrew
Lee, chief of plastic surgery at the University of Pittsburgh School of
Medicine.
